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Combination antibiotic therapy with macrolides improves survival in intubated patients with community-acquired pneumonia
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Combination antibiotic therapy with macrolides improves survival in intubated patients with community-acquired pneumonia
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Journal Article
Combination antibiotic therapy with macrolides improves survival in intubated patients with community-acquired pneumonia
2010
Overview
Objective
To assess the effect on survival of macrolides or fluoroquinolones in intubated patients admitted to the intensive care unit (ICU) with severe community-acquired pneumonia (severe CAP).
Methods
Prospective, observational cohort, multicenter study conducted in 27 ICUs of 9 European countries. Two hundred eighteen consecutive patients requiring invasive mechanical ventilation for an admission diagnosis of CAP were recruited.
Results
Severe sepsis and septic shock were present in 165 (75.7%) patients. Microbiological documentation was obtained in 102 (46.8%) patients. ICU mortality was 37.6% (
n
= 82). Non-survivors were older (58.6 ± 16.1 vs. 63.4 ± 16.7 years,
P
< 0.05) and presented a higher score on the simplified Acute Physiology Score II at admission (45.6 ± 15.4 vs. 50.8 ± 17.5,
P
< 0.05). Monotherapy was given in 43 (19.7%) and combination therapy in 175 (80.3%) patients. Empirical antibiotic therapy was in accordance with the 2007 Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) guidelines in 100 (45.9%) patients (macrolides in 46 patients and fluoroquinolones in 54). In this cohort, a Cox regression analysis adjusted by severity identified that macrolide use was associated with lower ICU mortality (hazard ratio, HR 0.48, confidence intervals, 95% CI 0.23–0.97,
P
= 0.04) when compared to the use of fluoroquinolones. When more severe patients presenting severe sepsis and septic shock were analyzed (
n
= 92), similar results were obtained (HR 0.44, 95% CI 0.20–0.95,
P
= 0.03).
Conclusions
Patients with severe community-acquired pneumonia had a low adherence with the 2007 IDSA/ATS guidelines. Combination therapy with macrolides should be preferred in intubated patients with severe CAP.
Publisher
Springer-Verlag,Springer,Springer Nature B.V
Subject
/ Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
/ Antibiotics. Antiinfectious agents. Antiparasitic agents
/ APACHE
/ Biological and medical sciences
/ Chronic obstructive pulmonary disease
/ Community-Acquired Infections - drug therapy
/ Community-Acquired Infections - epidemiology
/ Female
/ Fluoroquinolones - therapeutic use
/ Humans
/ Macrolides - therapeutic use
/ Male
/ Medicine
/ Original
/ Pharmacology. Drug treatments
/ Pneumology/Respiratory System
/ Sepsis
