Abstract
It remains uncertain whether patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and bacterial lower respiratory tract infections (LRTIs) could similarly benefit from β-lactam and macrolide antibiotics therapy as community-acquired pneumonia (CAP) does. In this study, we compared the clinical success rates of piperacillin/tazobactam (TZP) monotherapy versus its combination with erythromycin lactobionate injection (Ery) in patients with AECOPD and bacterial LRTIs and developed a machine learning (ML) model to predict treatment outcomes. The patients with AECOPD and bacterial LRTIs received antimicrobial therapy with either piperacillin-tazobactam (TZP) alone or TZP in combination with Ery. Inverse probability of treatment weighting (IPTW) was performed between the two groups. Subsequently, a stacking ensemble learning (SEL) model was developed and deployed as a web application to simultaneously predict clinical outcomes for both treatment options. The result demonstrated that TZP combined with Ery significantly reduced the incidence of clinical treatment failure compared to TZP monotherapy (14.00% vs. 19.75%; OR, 0.66; 95% CI, 0.49–0.89; P = 0.006). In an independent test set, the SEL model demonstrated strong performance across multiple metrics, including ROC-AUC (0.71), recall (sensitivity) (0.72), and accuracy (0.69). Finally, a web application based on the SEL was developed (http://106.12.146.54/). This study demonstrated that the addition of Ery to TZP significantly reduced clinical treatment failure in patients with AECOPD and bacterial LRTIs. This finding suggests that combination therapy may offer a clinical benefit in this patient population. Furthermore, an SEL model was developed to predict treatment outcomes for both regimens, providing a potential tool for future clinical decision-making and personalized treatment.
Data availability
Data supporting the findings of this study are available from the corresponding author upon reasonable request.
Abbreviations
- AECOPD:
-
Acute exacerbations of chronic obstructive pulmonary disease
- COPD:
-
Chronic obstructive pulmonary disease
- LRTIs:
-
Lower respiratory tract infections
- TZP:
-
Piperacillin-tazobactam
- ML:
-
Machine learning
- SEL:
-
Stacking ensemble learning
- IPTW:
-
Inverse probability of treatment weighting
- EGFR:
-
Estimated glomerular filtration rate
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Funding
This research is supported by grants from Key Discipline Construction Project of Pudong Health Bureau of Shanghai (Clinical Pharmacy) (to Huiping Lu, grant no PWZxk2022-27), the Health Commission of Pudong New Area Health and Technology Project (to Tao Yang, grant no PW2023A-31), Health Science and Technology of Shanghai Municipal Commission of Health Committee (to Fenfen Ma, grant no 20214Y0268), Plan of Artificial Intelligence-Driven Reform of Scientific Research Paradigms and Empowerment of Discipline Advancement (to Xinjuan Liu, grant no Z-2024-369-036), Key Discipline Project of Shanghai Pudong Hospital (to Ziqiang Zhang, grant no Yjzzzz2025-05) and Clinical Diagnosis and Treatment Innovation Research Project of Shanghai Pudong Hospital (to Yemeng Yang, grant no YJLC202409).
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TY, FFM, and JMW designed the study. YMY, TZ, and XZ served as the principal authors, responsible for conceiving, executing, and refining the majority of the analyses. Additionally, they played a pivotal role in drafting and polishing the manuscript. TY, YL, DQ, ZJZ, XJL, and FFM performed the statistical analysis of the data, contributed to editing the manuscript, and provided feedback. TY, FFM, and JMW supervised the project. All authors participated sufficiently in the study and take responsibility for the integrity of the work.
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This investigation was designed as a retrospective analysis based on previously collected clinical data and was conducted under a waiver of informed consent. The waiver was formally reviewed and approved by the Ethics Committee of Shanghai Pudong Hospital, Fudan University Pudong Medical Center, prior to the initiation of the study. Furthermore, the study protocol, developed in strict compliance with the ethical principles outlined in the Declaration of Helsinki and its subsequent revisions, received approval from the same committee (Approval No: 2024-KY-001-E01).
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Yang, Y., Zhang, T., Zheng, X. et al. Piperacillin/tazobactam plus erythromycin improves clinical outcomes in AECOPD with bacterial lower respiratory tract infections: a retrospective cohort study. Sci Rep (2026). https://doi.org/10.1038/s41598-026-44958-8
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DOI: https://doi.org/10.1038/s41598-026-44958-8
