Effectiveness of combination therapy versus monotherapy with a third-generation cephalosporin in bacteremic pneumococcal pneumonia. a propensity score analysis.
J Infect. 2018 Jan 19;:
Authors: De la Calle C, Ternavasio-de la Vega HG, Morata L, Marco F, Cardozo C, García-Vidal C, Del Rio A, Cilloniz C, Torres A, Martínez JA, Mensa J, Soriano A
Abstract
OBJECTIVE: combining a macrolide or a fluoroquinolone to beta-lactam regimens in the treatment of patients with moderate to severe community-acquired pneumonia is recommended by the international guidelines. However, the information in patients with bacteremic pneumococcal pneumonia is limited.
METHODS: a propensity score technique was used to analyse prospectively collected data from all patients with bacteremic pneumococcal pneumonia admitted from 2000 to 2015 in our institution, who had received empirical treatment with third generation cephalosporin in monotherapy or plus macrolide or fluoroquinolone.
RESULTS: we included 69 patients in the monotherapy group and 314 in the combination group. After adjustment by PS for receiving monotherapy, 30-day mortality (OR 2.89; 95% CI 1.07 - 7.84) was significantly higher in monotherapy group. A higher 30-day mortality was observed in monotherapy group in both 1:1 and 1:2 matched samples although it was statistically significant only in 1:2 sample (OR (CI95%): 3.50 (1.03 - 11.96), P=0.046).
CONCLUSIONS: our study suggests that in bacteremic pneumococcal pneumonia, empirical therapy with a third-generation cephalosporin plus a macrolide or a fluoroquinolone is associated with a lower mortality rate than beta-lactams in monotherapy. These results support the recommendation of combination therapy in patients requiring admission with moderate to severe disease.
PMID: 29360520 [PubMed - as supplied by publisher]