Decrease in Mortality in Severe Community-Acquired Pneumococcal Pneumonia: Impact of Improving Antibiotic Strategies (2000-2013).
Chest. 2013 Dec 26;
Authors: Gattarello S, Borgatta B, Solé-Violán J, Vallés J, Vidaur L, Zaragoza R, Torres A, Rello J, CAPUCI II study investigators
OBJECTIVE: To compare antibiotic prescribing practices and survival in the intensive care unit (ICU) in pneumococcal severe community-acquired pneumonia (SCAP) between 2000 and 2013.
MATERIALS AND METHODS: Matched case-control study of two prospectively recorded cohorts in Europe. Eighty patients from CAPUCI II (cases) were matched with 80 patients from CAPUCI I (controls) based on: shock at admission, need of mechanical ventilation, COPD, immunosuppression and age.
RESULTS: Demographic data were comparable in the two groups. Combined antibiotic therapy increased from 66.2% to 87.5% (p <0.01) and first dose of antibiotic was given within 3 hours from 27.5% to 70% (p <0.01). ICU mortality was significantly lower (OR 0.82, 95%CI 0.68-0.98) in cases, both in the whole population and in the subgroups of patients with shock (OR 0.67, 95%CI 0.50-0.89) or under mechanical ventilation (OR 0.73, 95%CI 0.55-0.96). In the multivariate analysis, ICU mortality increased in patients requiring mechanical ventilation (OR 5.23, 95%CI 1.60-17.17), and decreased in patients receiving early antibiotic treatment (OR 0.36, 95%CI 0.15-0.87) and combined therapy (OR 0.19, 95%CI 0.07-0.51).
CONCLUSIONS: In pneumococcal SCAP, early antibiotic prescription and use of combination therapy increased; both were associated with improved survival.
PMID: 24371840 [PubMed - as supplied by publisher]