Effect of Combined β-Lactam / Macrolide Therapy on Mortality According to the Microbial Aetiology and Inflammatory Status of Patients with Community - Acquired Pneumonia.
Chest. 2018 Nov 21;:
Authors: Ceccato A, Cilloniz C, Martin-Loeches I, Ranzani OT, Gabarrus A, Bueno L, Garcia-Vidal C, Ferrer M, Niederman MS, Torres A
BACKGROUND: Antibiotic combinations that include macrolides have shown lower mortality rates than β-lactams in monotherapy or combined with fluoroquinolones in patients with community-acquired pneumonia (CAP). However, this effect has not been studied according to the levels of C-reactive protein (CRP) in CAP with identified microbial cause.
OBJECTIVES: In patients with CAP and known microbial cause we aimed to evaluate 30 day mortality of a β-lactam plus macrolide (BL+M) compared to a fluoroquinolone alone with or without a β-lactam (FQ±BL) METHODS: We analysed a prospective observational cohort of patients with CAP admitted to Hospital Clinic of Barcelona between 1996 to 2016. We only included patients with known microbial cause.
RESULTS: Of 1,715(29%) patients with known aetiology, a total of 932 patients (54%) received BL+M. Despite a lower crude mortality in the BL+M group in the overall population (BL+M 5% vs. FQ±BL 8% p=0.015), after adjusted by a propensity score and baseline characteristics, the combination of BL+M had a protective effect on mortality only in patients with high inflammatory response (C-reactive protein >15 mg/dL) and pneumococcal CAP, (adjOR 0.28, 95%CI 0.09 to 0.93). No benefits on mortality were observed for the population without high inflammatory response and pneumococcal CAP or with other etiologies.
CONCLUSIONS: The combination of a β-lactam with a macrolide was associated with a decreased mortality in patients with pneumococcal CAP and, in patients with high systemic inflammatory response. When both factors occurred together, BL+M were protective for mortality in the multivariate analysis.
PMID: 30471269 [PubMed - as supplied by publisher]