Usefulness of β-lactam and macrolide combination therapy for treating community-acquired pneumonia patients hospitalized in the intensive care unit: Propensity score analysis of a prospective cohort study

被引：3

作者：

Ito, Akihiro ^{[1
]}

Ishida, Tadashi ^{[1
]}

Tachibana, Hiromasa ^{[1
,2
]}

Nakanishi, Yosuke ^{[1
]}

Tokioka, Fumiaki ^{[1
]}

Yamazaki, Akio ^{[1
,3
]}

Washio, Yasuyoshi ^{[1
,4
]}

Irie, Hiromasa ^{[5
]}

Otake, Takanao ^{[6
]}

机构：

[1] Kurashiki Cent Hosp, Ohara Healthcare Fdn, Dept Resp Med, 1-1-1 Miwa, Kurashiki, Okayama 7108602, Japan

[2] Natl Hosp Org Minami Kyoto Hosp, Dept Resp Med, 11 Nakaashihara, Joyo, Kyoto 6100113, Japan

[3] Shiga Univ Med Sci, Dept Resp Med, Otsu, Shiga 5202192, Japan

[4] Kyushu Univ, Grad Sch Med Sci, Res Inst Dis Chest, 3-1-1 Higashiku, Fukuoka 8128582, Japan

[5] Kurashiki Cent Hosp, Ohara Healthcare Fdn, Dept Anesthesia, 1-1-1 Miwa, Kurashiki, Okayama 7108602, Japan

[6] Kurashiki Cent Hosp, Ohara Healthcare Fdn, Dept Intens Care, Kurashiki, Okayama 7108602, Japan

来源：

JOURNAL OF INFECTION AND CHEMOTHERAPY | 2021年 / 27卷 / 10期

关键词：

beta-lactam antibiotics; Combination therapy; Community-acquired pneumonia; Intensive care unit; Macrolides; Prognosis; CRITICALLY-ILL PATIENTS; ANTIBIOTIC-THERAPY; GUIDELINES; MORTALITY; IMPACT; MONOTHERAPY; AMOXICILLIN; MANAGEMENT; ADHERENCE; SEVERITY;

D O I：

10.1016/j.jiac.2021.06.003

中图分类号：

R51 [传染病];

学科分类号：

100401 ;

摘要：

Introduction: Whether beta-lactam and macrolide combination therapy reduces mortality in severe community-acquired pneumonia (SCAP) patients hospitalized in the intensive care unit (ICU) is controversial. The aim of the present study was to evaluate the usefulness of beta-lactam and macrolide combination therapy for SCAP patients hospitalized in the ICU. Methods: A prospective, observational, cohort study of hospitalized pneumonia patients was performed. Hospitalized SCAP patients admitted to the ICU within 24 h between October 2010 and October 2017 were included for analysis. The primary outcome was 30-day mortality, and secondary outcomes were 14-day mortality and ICU mortality. Inverse probability of treatment weighting (IPTW) analysis as a propensity score analysis was used to reduce biases, including six covariates: age, sex, C-reactive protein, albumin, Pneumonia Severity Index score, and APACHE II score. Results: A total of 78 patients were included, with 48 patients in the non-macrolide-containing beta-lactam therapy group and 30 patients in the macrolide combination therapy group. beta-lactam and macrolide combination therapy significantly decreased 30-day mortality (16.7% vs. 43.8%; P = 0.015) and 14-day mortality (6.7% vs. 31.3%; P = 0.020), but not ICU mortality (10% vs 27.1%, P = 0.08) compared with non-macrolide-containing beta-lactam therapy. After adjusting by IPTW, macrolide combination therapy also decreased 30-day mortality (odds ratio, 0.29; 95%CI, 0.09-0.96; P = 0.04) and 14-day mortality (odds ratio, 0.19; 95%CI, 0.04-0.92; P = 0.04), but not ICU mortality (odds ratio, 0.34; 95%CI, 0.08-1.36; P = 0.13). Conclusions: Combination therapy with beta-lactam and macrolides significantly improved the prognosis of SCAP patients hospitalized in the ICU compared with a non-macrolide-containing beta-lactam regimen.

引用

页码：1447 / 1453

页数：7

共 37 条

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