Predictors for individual patient antibiotic treatment effect in hospitalised community-acquired pneumonia patients.
Clin Microbiol Infect. 2017 Mar 20;:
Authors: Simonetti AF, van Werkhoven CH, Schweitzer VA, Viasus D, Carratalà J, Postma DF, Oosterheert JJ, Bonten MJ
OBJECTIVE: Our objective was to identify clinical predictors of antibiotic treatment effects in non-ICU hospitalised CAP patients.
METHODS: Post-hoc analysis of three prospective cohorts (from the Netherlands and Spain) of CAP adult patients admitted to a non-ICU having received either beta-lactam monotherapy (BL), beta-lactam + macrolide (BLM), or fluoroquinolone-based therapy (FQL) as empiric antibiotic treatment. We evaluated candidate clinical predictors of treatment effects in multiple mixed-effects models by including interactions of the predictors with empiric antibiotic choice and using 30-day mortality, ICU admission, and length of hospital stay (LOS) as outcomes.
RESULTS: Among 8,562 patients, empiric treatment was BL in 4,399 (51.4%), FQL in 3,373 (39.4%), and BLM in 790 (9.2%). Older age (interaction OR 1.67, 95% CI 1.23 - 2.29, p-value 0.034) and current smoking (interaction OR 2.36, 95% C.I. 1.34 - 4.17, p-value 0.046) were associated with lower effectiveness of FQL on 30-day mortality. Older age was also associated with lower effectiveness of BLM on LOS (interaction effect ratio 1.14, 95% CI 1.06 - 1.22, p-value 0.008).
CONCLUSIONS: Older age and smoking could influence the response to specific antibiotic regimens. The effect modification of age and smoking should be considered hypothesis generating to be evaluated in future trials.
PMID: 28336384 [PubMed - as supplied by publisher]