TABLE 3. Survival for adults hospitalized with systemic anthrax, by specified treatment* comparisons, adjusted for illness severity — 1940–2018.
| Treatment comparison | No. of patients | Survived No. (%) |
No. of patients | Died No. (%) |
Multivariable analysis |
Variables analyzed |
|||
|---|---|---|---|---|---|---|---|---|---|
| OR (95% CI) | p value† | Hypoxia§ | Shock¶ | AMS | |||||
| Bactericidal drug(s) alone vs. PSI(s) alone |
66 |
60 (91) |
33 |
27 (82) |
4.57 (1.02–20.47) |
0.047 |
No |
Yes |
Yes |
| Bactericidal drug(s) and PSI(s) vs. bactericidal drug(s) alone |
86 |
26 (30) |
41 |
14 (34) |
1.54 (0.52–4.50) |
0.43 |
Yes |
Yes |
Yes |
| Bactericidal drug(s) and PSI(s) vs. PSI(s) alone |
32 |
26 (81) |
20 |
14 (70) |
3.60 (0.73–17.64) |
0.11 |
Yes |
No |
No |
| Bactericidal drug(s) and PSI(s) vs. bactericidal drug(s) alone or PSI(s) alone |
92 |
26 (28) |
47 |
14 (30) |
1.89 (0.67–5.31) |
0.23 |
Yes |
Yes |
Yes |
| Antimicrobial drug combination therapy vs. monotherapy** |
87 |
31 (36) |
47 |
25 (53) |
0.88 (0.33–2.35) |
0.80 |
Yes |
Yes |
Yes |
| Antimicrobial drug(s) and antitoxin/antiserum vs. antimicrobial drug(s) | 100 | 7 (7) | 55 | 5 (9) | 1.31 (0.24–7.07) | 0.75 | Yes | Yes | Yes |
Source: Person MK, Cook R, Bradley JS, Hupert N, Bower WA, Hendricks K. Systematic review of hospital treatment outcomes for naturally acquired and bioterrorism-related anthrax, 1880–2018. Clin Infect Dis 2022;75(Suppl 3):S392–401.
Abbreviations: AMS = altered mental status; OR = odds ratio; PSI = protein synthesis inhibitor.
* Patients are only included in each row if they had the specified treatment being compared. Patients are considered to have the specified treatment if administered in the first 2 days of hospitalization. Patients are classified as having no antimicrobial drug treatment if they did not receive any antimicrobial drugs throughout hospitalization. Patients were excluded from analysis if they were dead on arrival, died on day 1 of hospitalization, or if survival status was unknown. Patients who were administered antimicrobial drugs appropriate for anthrax treatment before hospitalization also were excluded. Sulfa drugs and cephalosporins are not considered appropriate for anthrax treatment and therefore did not contribute to the count of antimicrobial drugs. Patients who were administered antitoxin/antiserum at any time in the course of their treatment were excluded except when comparing antimicrobial drugs and antitoxin/antiserum to antimicrobial drugs alone. Certain patients were excluded because of missing sign, symptom, and treatment data (Source: Meselson M, Guillemin J, Hugh-Jones M, et al. The Sverdlovsk anthrax outbreak of 1979. Science 1994;266:1202–8).
† p value calculated by Wald chi-square; p<0.05 was considered statistically significant.
§ Ventilated or intubated or respiratory rate >30 breaths per minute.
¶ Administered vasopressors or systolic blood pressure <90 mm Hg.
** Included one anthrax meningitis patient whose illness did not meet the definition of systemic.