Therapeutic Effectiveness of Cefoperazone for Community-Acquired Pneumonia and Associated Factors in a Tertiary Care Hospital, Vietnam


Cefoperazone monotherapy
CURB-65 scores
antibiotic sensitivity testing
community-acquired pneumonia

How to Cite

Le, C. N., Nguyen, D. T., Kaewsawat, S. ., Suwangbamrung, . C., & Khammaneechan, P. (2021). Therapeutic Effectiveness of Cefoperazone for Community-Acquired Pneumonia and Associated Factors in a Tertiary Care Hospital, Vietnam. Journal of Pharmacy and Nutrition Sciences, 11, 20–27.


Purpose: This study aimed to (i) identify the pathogenic bacterial profile and Cefoperazone (CPZ) sensitivity; (ii) assess the therapeutic effectiveness of CPZ and (iii) determine factors associating with the treatment success.

Patients and methods: The retrospective study was conducted in Kien Giang hospital, Vietnam. Sample size was 210 medical records of community-acquired pneumonia (CAP) patients admitted to the hospital from January to December 2018. The Chi square and Fisher’s exact test were used to determine factors associating with the treatment success such as age, gender, comorbidities, levels of CAP severity respiratory rate, PaO2, and laboratory findings of blood tests. Statistical significance was at level α = 0.05.

Results: The main pathogenic bacteria were Klebsiella pneumoniae (29.1%), Streptococcus pneumoniae (26.7%) and Pseudomonas aeruginosa (14%), and were highly susceptible to CPZ. Mean duration of obtaining clinical stability was 3.01 days. The obtainment of clinical stability through CPZ monotherapy on the third, fifth and seventh day of treatment process accounted for 78.9%, 87.6% and 100% of total cases, respectively. CPZ achieved a highly successful rate in the monotherapy (79.07%) if the treatment was guided by antibiotic sensitivity testing results. The association between the treatment success and factors such as age, respiratory rate, and severity category of CAP were statistically significant (p<0.05).

Conclusion: Minimizing CPZ resistance, and CPZ overuse during CAP therapy is necessary. The factors associating with the success of therapy are useful in predicting the prognosis of CAP patients, planning the sequential therapy, and determining hospital discharge.


Canan G, Mehmet ST, Abdullah S, Aykut Ç, Oğuz K, Ayşın ŞC.Factors affecting treatment success in community-acquired pneumonia. Turk J Med Sci2016; 46(5): 1469-1474.

Navdeep KB, Michael SN. Management of community-acquired pneumonia: a review and update. Ther Adv Respir Dis 2010; 5(1): 61-78.

Peto L, Nadjm B, Horby P.The bacterial etiology of adult community acquired pneumonia in Asia: a systematic review. Trans R Soc Trop Med Hyg 2014; 108: 326-337.

Antonella FS, Diego V, Carolina GV, Jordi C. Management of community-acquired pneumonia in older adults.Therapeutic Advances in Infectious Disease 2014; 2(1): 3-16.

Ying L, Yuling S, Shuhong D, Ping Z,Zhongying B.Pathogenic bacterial profile and drug resistance analysis of community-acquired pneumonia in older outpatients with fever. J Int Med Res 2018; 46(11): 4596-4604.

Rxlist. Drug Description.Cefobid.Available from:

Vietnamese Ministry of Health.Vietnam National Pharmacopoeia. 5th ed. Hanoi 2018.

Jien WL, Yen HC, Wen SL, Jung CL, Ching TH, His HL, et al.Randomized Noninferiority Trial of Cefoperazone-Sulbactam versus Cefepime in the Treatment of Hospital-Acquired and Healthcare-Associated Pneumonia. AntimicrobAgents Chemother 2019; 63(8): 19-23.

Vietnamese Ministry of Health. Guidelines for Antibiotic Uses 2015; 93-98

Ethan AH, Michael JF, Thomas JM, Christopher MC, Wishwa NK, D Scott O, et al. Time to Clinical Stability in Patients Hospitalized With Community-Acquired Pneumonia Implications for Practice Guidelines. JAMA 1998; 279(18): 1452-1457.

Lionel AM, Richard GW, Antonio A, John GB, Douglas C, Nathan CD, et al. Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults. Arch.Clin.Infect. Dis. 2007; 44 (Supplement_2): S27-S72.

MDCALC. CURB-65 Scores for pneumonia severity. Available from: severity#: ~: text=The%20CURB%2D65%20calculator%20can,to%20a%20variety%20of%20factos .

Ying L, Yuling S, Shuhong D. Pathogenic bacterial profile and drug resistance analysis of community-acquired pneumonia in older outpatients with fever. IntJMedRes2018; 46(11): 4596-4604.

Brown JS. Geography and the aetiology of community -acquired pneumonia. Respirology 2009; 14 (8): 1068-1071.

Ko WC, Paterson DL, Sagnimeni AJ.Community-acquired Klebsiella pneumoniae bacteremia: global differences in clinical patterns. Emerg Infect Dis 2002; 8: 160-166.

Kollef MH, Shorr A, Tabak YP. Epidemiology and outcomes of health-care-associated pneumonia: results from a large US database of culture-positive pneumonia. Chest 2005; 128: 3854-3862.

Chalmers JD, Taylor JK, Singanayagam A. Epidemiology, antibiotic therapy, and clinical outcomes in health care-associated pneumonia: a UK cohort study. Clin Infect Dis2011; 53: 107-113.

Jain S, Self WH, Wunderink RG. Community-acquired pneumonia requiring hospitalization among U. S. adults. N Engl J Med 2015; 373: 415-427.

Aliberti S, Reyes LF, Faverio P. Global initiative for meticillin-resistant Staphylococcus aureus pneumonia (GLIMP): an international, observational cohort study. Lancet Infect Dis2016; 16: 1364-1376.

Tsung TC, Hung JT, Cheng HC, Te LC, Mao WH, ChenHL, et al.Antimicrobial Activities of Cefoperazone sulbactam in Comparison to Cefoperazone against Clinical Organisms from Medical Centers in Taiwan. JMed Sci 2016; 36(6): 229-233.

Duong L H, Pham P L. Current situation of antibiotic use in treating adult pneumonia at I Agricultural Hospital. Viet J Public Health.2013; 31-39.

Cao X T. Evaluation of appropriate antibiotic treatment efficacy in severe pneumonia in the respiratory department of Cho Ray hospital. J Med of HCM city.2009; 14: 142-147.

Syed IA, Nadia H, Claire P, Patrick M, Duane R, Robert W. et al.Nursing home-acquired pneumonia: course and management in the emergency department. IntJEmergMed2014; 7: 19.

HalmEA,FineMJ,MarrieTJ.Time to clinical stability in patients hospitalized with community-acquired pneumonia: implications for practice guidelines. JAMA 1998; 279(18): 1452-1457.

Rosario M, Antoni T, Felipe RC, Rafael Z, Javier A, Juan JV, et al.Reaching Stability in Community-Acquired Pneumonia: The Effects of the Severity of Disease, Treatment, and the Characteristics of Patients. Clin.Infect. Dis 2004; 39 (12): 1783-1790.

Akihiro I, Tadashi I, Hironobu T, Yasuyoshi W, Akio Y, Yuhei I, et al. Prognostic factors in hospitalized community-acquired pneumonia: a retrospective study of a prospective observational cohort. BMC Pulm 2017; 17(1): 78-79.

Majhi A, Kundu K, Adhikary R. Combination therapy with ampicillin and azithromycin in an experimental pneumococcal pneumonia is bactericidal and effective in down regulating inflammation in mice. J Inflamm 2014; 11(1): 5.

Lim WS, Eerden van der MM, Laing R. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax2003; 58(5): 377-382.

Miyashita N, Matsushima T, Oka M. Japanese Respiratory Society. The JRS guidelines for the management of community-acquired pneumonia in adults: an update and new recommendations. Intern Med 2006; 45(7): 419-428.

Sirvent JM, Carmen TM, Lorencio C. Predictive factors of mortality in severe community-acquired pneumonia: a model with data on the first 24 h of ICU admission. Med Intensiva2013; 37: 308-315.

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