Impact of guideline-concordant antibiotics and macrolide/β-lactam combinations in 3203 patients hospitalized with pneumonia: prospective cohort study
Clinical Microbiology and Infection, 04/19/2012
Asadi L et al. – The guideline–concordant antibiotics were not associated with decreased mortality for patients hospitalized with pneumonia, but were associated with a decrease in the composite endpoint of death or ICU admission. The findings do not support any clinical advantage of macrolide/ β–lactam compared with respiratory fluoroquinolone monotherapy.Methods
- The study included 3203 patients and most had severe pneumonia (63% PSI Class IV-V).
- Three hundred and twenty-one (10.0%) patients died, 306 (9.6%) were admitted to the ICU and 570 (17.8%) achieved the composite of death or ICU admission.
- Most (n = 2506) patients received guideline-concordant antibiotics.
- Receipt of guideline-concordant antibiotics was not associated with a reduction in mortality alone (231 (9.2%) vs. 90 (12.9%); adjusted odds ratio (aOR), 0.82; 95% CI, 0.61–1.09; p 0.16), but was associated with decreased death or ICU admission (14.7% vs. 29.0%; aOR, 0.44; 95% CI, 0.36–0.54; p <0.0001).
- Within guideline-concordant subgroups, there was no difference in mortality between macrolide/ β-lactams and respiratory fluoroquinolone monotherapy (22 (8.3%) vs. 209 (9.3%); aOR, 1.09; 95% CI, 0.66–1.81; p 0.73) but macrolide/ β-lactams were associated with increased odds of death or ICU admission (17.4% vs. 14.4%; aOR, 1.58; 95% CI, 1.09–2.27; p 0.01).