Effectiveness of combination therapy versus monotherapy with a third-generation cephalosporin in bacteraemic pneumococcal pneumonia: A propensity score analysis
Effectiveness of combination therapy versus monotherapy with a third-generation cephalosporin in bacteraemic pneumococcal pneumonia: A propensity score analysis
复制标题
DOI：
10.1016/j.jinf.2018.01.003
复制
发表时间：
2018-04-01
影响因子：
28.2
通讯作者：
Soriano, A.
中科院分区：
文献类型：
--
作者：
De la Calle, C.;Ternavasio-de la Vega, H. G.;Soriano, A.
目的：国际指南推荐将大环内酯类或氟喹诺酮类药物与β-内酰胺类药物联合治疗中重度社区获得性肺炎患者。然而，菌血症肺炎球菌肺炎患者的信息有限。方法：采用倾向评分技术对我机构2000年至2015年收治的所有菌血症肺炎球菌肺炎患者进行前瞻性收集的数据分析，这些患者接受过第三代头孢菌素单药治疗或联合大环内酯类药物或大环内酯类药物的经验治疗。 结果：我们纳入了单药治疗组 69 名患者和联合治疗组 314 名患者。根据接受单一疗法的 PS 进行调整后，单一疗法组的 30 天死亡率（OR 2.89；95% CI 1.07-7.84）显着较高。在 1:1 和 1:2 匹配样本中，单药治疗组的 30 天死亡率较高，尽管仅在 1:2 样本中具有统计学意义（OR：3.50（95% CI 1.03-11.96），P = 0.046）。 结论：我们的研究表明，在菌血症性肺炎球菌肺炎中，采用第三代头孢菌素加 在单一疗法中，大环内酯类或氟喹诺酮类药物的死亡率低于β-内酰胺类药物。这些结果支持对需要入院的中度至重度疾病患者进行联合治疗的建议。 (c) 2018 年英国感染协会。由爱思唯尔有限公司出版。保留所有权利。
Objective: Combining a macrolide or a fluoroquinolone to beta-lactam regimens in the treatment of patients with moderate to severe community-acquired pneumonia is recommended by the international guidelines. However, the information in patients with bacteraemic pneumococcal pneumonia is limited.Methods: A propensity score technique was used to analyze prospectively collected data from all patients with bacteraemic pneumococcal pneumonia admitted from 2000 to 2015 in our institution, who had received empirical treatment with third-generation cephalosporin in monotherapy or plus macrolide or fluoroquinolone.Results: We included 69 patients in the monotherapy group and 314 in the combination group. After adjustment by PS for receiving monotherapy, 30-day mortality (OR 2.89; 95% CI 1.07-7.84) was significantly higher in monotherapy group. A higher 30-day mortality was observed in monotherapy group in both 1:1 and 1:2 matched samples although it was statistically significant only in 1:2 sample (OR: 3.50 (95% CI 1.03-11.96), P = 0.046).Conclusions: Our study suggests that in bacteraemic pneumococcal pneumonia, empirical therapy with a third-generation cephalosporin plus a macrolide or a fluoroquinolone is associated with a lower mortality rate than beta-lactams in monotherapy. These results support the recommendation of combination therapy in patients requiring admission with moderate to severe disease. (c) 2018 The British Infection Association. Published by Elsevier Ltd. All rights reserved.