Impact of intravenous β-lactam/macrolide versus β-lactam monotherapy on mortality in hospitalized patients with community-acquired pneumonia

被引:66
作者
Tessmer, A. [1 ]
Welte, T. [2 ]
Martus, P. [3 ]
Schnoor, M. [4 ]
Marre, R. [5 ]
Suttorp, N. [1 ]
机构
[1] Charite, Dept Infect Dis & Resp Med, D-13353 Berlin, Germany
[2] Hannover Med Sch, Dept Pulm Med, Hannover, Germany
[3] Charite, Dept Biometry & Clin Epidemiol, D-13353 Berlin, Germany
[4] Med Univ Schleswig Holstein, Inst Social Med, Campus Luebeck, Germany
[5] Univ Ulm, Dept Med Microbiol & Hyg, D-89069 Ulm, Germany
关键词
antibiotic therapy; community-acquired infection; treatment failure; INITIAL ANTIBIOTIC CHOICE; ANTIMICROBIAL THERAPY; MEDICAL OUTCOMES; ELDERLY-PATIENTS; MACROLIDES; ASSOCIATIONS; GUIDELINES; MANAGEMENT;
D O I
10.1093/jac/dkp088
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Guidelines recommend dual-therapy consisting of a beta-lactam/macrolide (BLM) for hospitalized patients with community-acquired pneumonia. Nevertheless, the superiority over beta-lactam-monotherapy (BL) remains unproven. Analyses from an observational study initiated by the German competence network CAPNETZ were performed. One thousand eight hundred and fifty-four patients were treated with either BL (49.0%) or BLM (51.0%). BLM therapy was associated with lower adjusted 14 day mortality [odds ratio (OR) 0.53; 95% confidence interval (CI): 0.30-0.94]. CRB65, neoplastic disease, age and nursing home residency were confirmed as independent predictors of death. Adjusted 14 day mortality risk was clearly reduced in patients with CRB65 = 2 (n = 411; OR 0.35; CI: 0.12-0.99) and CRB65 >= 2 (n = 519; OR 0.42; CI: 0.18-0.997). However, this could not be shown for adjusted 30 day mortality. Patients with CRB65 <= 1 showed low mortality (2.1%) without the influence of BLM. BLM therapy was associated with lower adjusted risk of treatment failure at 14 days (n = 1854; OR 0.65; CI: 0.47-0.89) and 30 days (OR 0.69; CI: 0.51-0.94) as well as in the subgroup of patients with CRB65 = 2 and CRB65 >= 2. This study suggests the superiority of BLM therapy in patients with CRB65 risk classes of 2 or higher on 14 day mortality. BLM therapy was also associated with lower risk of treatment failure.
引用
收藏
页码:1025 / 1033
页数:9
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