Open Access Research article

Multivariate analysis of prognostic factors in patients with pulmonary actinomycosis

Ji Young Park1, Taehoon Lee1, Hongyeul Lee1, Hyo-Jeong Lim1, Jinwoo Lee2, Jong Sun Park1, Young-Jae Cho1, Young Sik Park2, Chang-Hoon Lee2, Sang-Min Lee2, Ho Il Yoon1, Jae-Joon Yim2, Chul-Gyu Yoo2, Young Whan Kim2, Sung Koo Han2, Choon-Taek Lee1 and Jae Ho Lee13*

Author Affiliations

1 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea

2 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea

3 Department of Internal Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, the Republic of Korea

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BMC Infectious Diseases 2014, 14:10  doi:10.1186/1471-2334-14-10

Published: 9 January 2014

Abstract

Background

There have been few studies of pulmonary actinomycosis, which is an uncommon anaerobic infection. Consequently, the optimal therapeutic regimen, appropriate duration of treatment, long-term prognosis, and factors predicting prognosis are not well established.

Methods

We retrospectively reviewed the medical records of histopathologically confirmed cases of pulmonary actinomycosis seen between November 2003 and December 2012.

Results

The study included 68 patients with a mean age of 58.4 ± 11.6 years. Of the 68, initial surgery was performed in 15 patients (22.1%), while the remaining 53 (77.9%) received antibiotic therapy initially. In the initial antibiotic group, 45/53 (84.9%) were cured without relapse (median antibiotic duration 5.3 months). 5/53 (9.4%) patients were refractory medically (median antibiotic duration 9.7 months), and 3/53 (5.7%) experienced a recurrence (median time to relapse 35.3 months). In the initial surgery group, 14/15 (93.3%) were cured and treatment failure occurred in one (6.7%). In the multivariate analysis, the absence of an antibiotic response at 1 month was the only independent factor associated with a poor treatment outcome, with an adjusted odds ratio of 49.2 (95% CI, 3.34–724.30). There was no significant difference in treatment outcome based on the size of the parenchymal lesion, comorbidities, whether intravenous antibiotics were used, antibiotic therapy duration, or whether the initial treatment was surgical.

Conclusions

Antibiotic treatment with or without surgery was effective for treatment of pulmonary actinomycosis. Nevertheless, treatment failure or recurrence occurred in a considerable proportion of patients, especially those resistant to the initial antibiotic treatment.

Keywords:
Actinomycosis; Anti-bacterial agents; Treatment outcome; Prognostic factors; Pulmonary