Macrolide therapy is associated with lower mortality in community-acquired bacteraemic pneumonia
Macrolide therapy is associated with lower mortality in community-acquired bacteraemic pneumonia
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DOI：
10.1016/j.rmed.2018.05.020
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发表时间：
2018-07-01
影响因子：
4.3
通讯作者：
Feldman, Charles
中科院分区：
文献类型：
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作者：
Arnold, Forest W.;Lopardo, Gustavo;Feldman, Charles
背景：社区获得性肺炎（CAP）有潜在的菌血症并发症。本研究的目的是定义CAP和菌血症患者的临床结局，治疗和不治疗的大环内酯类药物。材料和方法：社区获得性肺炎组织的CAP住院患者数据库的二次分析。血培养阳性的患者根据其初始抗菌方案中是否存在大环内酯类药物以及CAP的严重程度进行分类。结果包括院内全因死亡率，30天死亡率，住院时间，临床stability.Results：在549例CAP和菌血症患者中，247例（45%）用大环内酯类药物治疗，302例（55%）没有。主要病原菌为肺炎链球菌（74%）。Poisson回归和稳健的误差方差模型用于比较每个研究组对结果的调整效果。未校正的30天死亡率在大环内酯类药物组为18.4%，在非大环内酯类药物组为29.6%（校正的相对危险度（aRR）0.81; 95%置信区间（CI）0.50-1.33; P = 0.41）。大环内酯类药物组和非大环内酯类药物组未校正的院内全因死亡率分别为7.3%和18.9%（aRR 0.54，95%CI 0.30-0.98; P = 0.043）。住院时间和临床稳定的时间没有显着different.Conclusions：住院死亡率，但不是30天的死亡率，是显着更好的大环内酯类药物组。我们的数据支持使用大环内酯类抗生素治疗CAP和菌血症住院患者。
Background: Community-acquired pneumonia (CAP) has a potential complication of bacteremia. The objective of this study was to define the clinical outcomes of patients with CAP and bacteremia treated with and without a macrolide.Materials and methods: Secondary analysis of the Community-Acquired Pneumonia Organization database of hospitalized patients with CAP. Patients with a positive blood culture were categorized based on the presence or absence of a macrolide in their initial antimicrobial regimen, and severity of their CAP. Outcomes included inhospital all-cause mortality, 30-day mortality, length of stay, and time to clinical stability.Results: Among 549 patients with CAP and bacteremia, 247 (45%) were treated with a macrolide and 302 (55%) were not. The primary pathogen was Streptococcus pneumoniae (74%). Poisson regression with robust error variance models were used to compare the adjusted effects of each study group on the outcomes. The unadjusted 30-day mortality was 18.4% in the macrolide group, and 29.6% in the non-macrolide group (adjusted relative risk (aRR)0.81; 95% confidence interval (CI)0.50-1.33; P = 0.41). Unadjusted in-hospital all-cause mortality was 7.3% in the macrolide group, and 18.9% in the non-macrolide group (aRR 0.54, 95% CI 0.30-0.98; P = 0.043). Length of stay and time to clinical stability were not significantly different.Conclusions: In-hospital mortality, but not 30-day mortality, was significantly better in the macrolide group. Our data support the use of a macrolide in hospitalized patients with CAP and bacteraemia.