Associations between empirical antimicrobial therapy at the hospital and mortality in patients with severe community-acquired pneumonia

Rello, Jordi; Catalán, M.; Dı́az, Emili; Bodí, M.; Alvarez, B.

doi:10.1007/s00134-002-1325-3

Cited by 51 publications

(34 citation statements)

References 14 publications

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“…2,3 It is the most frequent cause of community-acquired infections among patients admitted to intensive care units. 4 In addition, it is among the leading causes of death worldwide.…”

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confidence: 99%

Respiratory fluoroquinolones for the treatment of community-acquired pneumonia: a meta-analysis of randomized controlled trials

Vardakas¹,

Siempos²,

Grammatikos³

et al. 2008

Canadian Medical Association Journal

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CMAJ ResearchBackground: We investigated whether the use of respiratory fluoroquinolones was associated with better clinical outcomes compared with the use of macrolides and β-lactams among adults with pneumonia. Methods:We searched PubMed, Current Contents, Scopus, EMBASE, ClinicalTrials.gov and Cochrane with no language restrictions. Two reviewers independently extracted data from published trials that compared fluoroquinolones (levofloxacin, moxifloxacin, gemifloxacin) with macrolides or β-lactams or both. A meta-analysis was performed with the clinical outcomes of mortality, treatment success and adverse outcomes. Results:We included 23 trials in our meta-analysis. There was no difference in mortality among patients who received fluoroquinolones or the comparator antibiotics (OR 0.85, 95% CI 0.65-1.12). Pneumonia resolved in more patients who received fluoroquinolones compared with the comparator antibiotics for the included outcomes in the intention-to-treat population (OR 1.17, 95% CI 1.00-1.36), clinically evaluable population (OR 1.26, 95% CI 1.06-1.50) and the microbiologically assessed population (OR 1.67, 95% CI 1.28-2.20). Fluoroquinolones were more effective than a combination of β-lactam and macrolide (OR 1.39, 95% CI 1.02-1.90). They were also more effective for patients with severe pneumonia (OR 1.84, 95% CI 1.02-3.29), those who required admission to hospital (OR = 1.30, 95% CI 1.04-1.61) and those who required intravenous therapy (OR = 1.44, 15% CI 1.13-1.85). Fluoroquinolones were more effective than β-lactam and macrolide in open-label trials (OR = 1.35, 95% CI 1.08-1.69) but not in blinded randomized controlled trials (OR = 1.13, 95% CI 0.85-1.50).Interpretation: Fluoroquinolones were associated with higher success of treatment for severe forms of pneumonia; however, a benefit in mortality was not evident. A randomized controlled trial that includes patients with severe pneumonia with or without bacteremia is needed.

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“…2,3 It is the most frequent cause of community-acquired infections among patients admitted to intensive care units. 4 In addition, it is among the leading causes of death worldwide.…”

mentioning

confidence: 99%

Respiratory fluoroquinolones for the treatment of community-acquired pneumonia: a meta-analysis of randomized controlled trials

Vardakas¹,

Siempos²,

Grammatikos³

et al. 2008

Canadian Medical Association Journal

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“…Clinicians' decisions to prescribe combinations of antibiotics are based on factors relevant to the individual patient [10,36] and, consequently, many factors in addition to antibiotic therapy could have accounted for the present results. In fact, as the current authors have stated, initial antimicrobial choice is related to baseline severity of illness.…”

Section: Discussionmentioning

confidence: 99%

“…Several retrospective studies have suggested that the use of a macrolides/b-lactams combination, as part of the initial antimicrobial treatment, for patients with CAP, requiring hospital admission, may shorten the hospital stay [6,7] and reduce the mortality rate in comparison with those treated with monotherapy [8][9][10], even when S. pneumoniae is finally identified as the causative organism [11][12][13]. However, many aspects of the apparently beneficial effects of combined therapy remain unclear and/or controversial.…”

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confidence: 99%

“…There are inconsistencies in reported outcomes and confusing biases that may have influenced these results. For instance, groups receiving the b-lactam/ macrolide combination, as opposed to monotherapy, are not comparable with regard to the average prognosis [10]. In a retrospective study on 213 hospitalised patients, BURGESS and LEWIS [14] concluded that it may not be necessary to add a macrolide to a nonpseudomonal thirdgeneration cephalosporin in the initial empirical …”

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confidence: 99%

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Impact of initial antibiotic choice on mortality from pneumococcal pneumonia

Aspa¹,

Rajas²,

Castro³

et al. 2006

Eur Respir J

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To determine the impact of initial antimicrobial choice on 30-day mortality rate in patients with community-acquired pneumonia due to Streptococcus pneumoniae (CAP-SP), a prospective, observational study was conducted in 35 Spanish hospitals. A total of 638 patients with CAP-SP were identified. Antimicrobials were chosen by the attending physician. Patients were grouped into the following categories: b-lactam monotherapy (n5251), macrolide monotherapy (n537), b-lactam plus macrolide (n5198), levofloxacin alone/combination (n548), and other combinations (n5104). The reference category was b-lactam+macrolide.The 30-day survival probability was 84.9%. Using multivariate survival analysis, factors related to mortality in the entire population were: bilateral disease, suspected aspiration, shock, HIV infection, renal failure and pneumonia severity index (PSI) score Class IV versus I-III and categories V versus I-III. The association of b-lactams+macrolides was not better than the use of b-lactams alone. The current authors analysed the different groups of patients with significant mortality/morbidity: intensive care unit, PSI Class .III, renal failure, chronic lung disease and bacteraemia. Only in patients with PSI Class .III, who had undergone initial antimicrobial choice classified as other combinations, were associated with higher mortality.In conclusion, the current authors have not demonstrated an independent association between initial antimicrobial regimen and 30-day mortality in community-acquired pneumococcal pneumonia patients, except for those with a higher pneumonia severity index score.

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“…trapulmonales Organversagen infolge einer schweren, durch die CAP bedingte Sepsis. 50 bis 75 % der Todesfälle sind direkt durch die Pneumonie bedingt [220] (2b), [298] Die Option wird weiter unterstützt durch retrospektive Analysen über den Zusammenhang zwischen der Krankenhausletalität und der Art der kalkulierten antimikrobiellen Therapie bei sCAP [38] (2b), [255] (2c), [256] …”

Section: Einleitung Der Intensivtherapieunclassified

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2005

Pneumologie

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Associations between empirical antimicrobial therapy at the hospital and mortality in patients with severe community-acquired pneumonia

Cited by 51 publications

References 14 publications

Respiratory fluoroquinolones for the treatment of community-acquired pneumonia: a meta-analysis of randomized controlled trials

Respiratory fluoroquinolones for the treatment of community-acquired pneumonia: a meta-analysis of randomized controlled trials

Impact of initial antibiotic choice on mortality from pneumococcal pneumonia

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