Antibiotics for bacteremic pneumonia - Improved outcomes with macrolides but not fluoroquinolones
Antibiotics for bacteremic pneumonia - Improved outcomes with macrolides but not fluoroquinolones
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DOI：
10.1378/chest.06-1426
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发表时间：
2007-02-01
期刊：
影响因子：
9.6
通讯作者：
Bratzler, Dale W.
中科院分区：
文献类型：
--
作者：
Meterky, Mark L.;Ma, Allen;Bratzler, Dale W.
背景：使用对非典型生物有活性的抗生素是否有益于社区获得性肺炎的治疗以及任何有益作用的潜在机制的问题仍未得到解决。提出的机制包括针对非典型生物的活性与这些抗生素的免疫调节作用。对大量菌血症肺炎患者结果的研究通过排除原发性非典型感染患者，为解决这些问题提供了一个独特的机会。方法：我们回顾了 2,209 名 Medicare 患者的图表数据，这些患者在 1998 年至 2001 年间从家里或护理机构因菌血症肺炎入院。根据抗生素治疗类型对患者进行分层。采用多变量模型评估所用抗生素类别与多个结果变量之间的关系。 结果：首次使用任何对非典型生物具有活性的抗生素与 30 天死亡率风险降低（比值比 [OR]，0.76；95% 置信区间 [CI]，0.59 至 0.98；p = 0.03）和出院 30 天内入院风险降低（OR，0.67；p = 0.03）独立相关。 95% CI，0.51 至 0.89；p = 0.02）。进一步分析显示，非典型治疗的益处与大环内酯类药物的使用有关，但与氟喹诺酮类或四环素类药物的使用无关，大环内酯类药物可降低院内死亡风险（OR，0.59；95% CI，0.40 至 0.88；p = 0.01）、30 天死亡率（OR，0.61；95% CI，0.43 至0.87；p = 0.007），出院 30 天内再次入院（OR，0.59；95% CI，0.42 至 0.85；p = 0.004）。结论：包括大环内酯类药物在内的初始抗生素治疗与因菌血症住院的 Medicare 患者的预后改善相关。这些结果对于使用大环内酯类药物治疗肺炎与改善预后相关的机制具有影响。
Background: The questions of whether the use of antibiotics that are active against atypical organisms is beneficial in the treatment of community-acquired pneumonia and of the potential mechanisms of any beneficial effects remain unresolved. Proposed mechanisms include activity against atypical organisms vs the immunomodulatory effects of these antibiotics. The study of outcomes of a large cohort of patients with bacteremic pneumonia provides a unique opportunity to address these questions by excluding patients with primary atypical infection.Methods: We reviewed data from the charts of 2,209 Medicare patients who were admitted to hospitals across the United States from either home or a nursing facility with bacteremic pneumonia between 1998 and 2001. Patients were stratified according to the type of antibiotic treatment. Multivatiate modeling was performed to assess the relationship between the class of antibiotic used and several outcome variables.Results: The initial use of any antibiotic active against atypical organisms was independently associated with a decreased risk of 30-day mortality (odds ratio [OR], 0.76; 95% confidence interval [CI], 0.59 to 0.98; p = 0.03) and hospital admission within 30 days of discharge (OR, 0.67; 95% CI, 0.51 to 0.89; p = 0.02). Further analysis revealed that the benefits of atypical treatment were associated with the use of macrolides, but not the use of fluoroquinolones or tetracyclines, with macrolides conferring lower risks of in-hospital mortality (OR, 0.59; 95% CI, 0.40 to 0.88; p = 0.01), 30-day mortality (OR, 0.61; 95% CI, 0.43 to 0.87; p = 0.007), and hospital readmission within 30 days of discharge (OR, 0.59; 95% CI, 0.42 to 0.85; p = 0.004).Conclusions: Initial antibiotic treatment including a macrolide agent is associated with improved outcomes in Medicare patients hospitalized with bacteremic pneumonia. These results have implications regarding the mechanism by which the use of a macrolide for treatment of pneumonia is associated with improved outcomes.