Mortality in patients with community-onset pneumonia at low risk of drug-resistant pathogens: Impact of β-lactam plus macrolide combination therapy
Junya Okumura
Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
Search for more papers by this authorCorresponding Author
Yuichiro Shindo
Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
Correspondence: Yuichiro Shindo, Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan. Email: [email protected]Search for more papers by this authorKunihiko Takahashi
Department of Biostatistics, Nagoya University Graduate School of Medicine, Nagoya, Japan
Search for more papers by this authorMasahiro Sano
Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
Search for more papers by this authorYasuteru Sugino
Department of Respiratory Medicine, Toyota Memorial Hospital, Toyota, Japan
Search for more papers by this authorTetsuya Yagi
Department of Infectious Diseases, Nagoya University Hospital, Nagoya, Japan
Search for more papers by this authorHiroyuki Taniguchi
Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Japan
Search for more papers by this authorHideo Saka
Department of Respiratory Medicine, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
Search for more papers by this authorShigeyuki Matsui
Department of Biostatistics, Nagoya University Graduate School of Medicine, Nagoya, Japan
Search for more papers by this authorYoshinori Hasegawa
Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
Search for more papers by this authoron behalf of the Central Japan Lung Study Group
Search for more papers by this authorJunya Okumura
Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
Search for more papers by this authorCorresponding Author
Yuichiro Shindo
Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
Correspondence: Yuichiro Shindo, Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan. Email: [email protected]Search for more papers by this authorKunihiko Takahashi
Department of Biostatistics, Nagoya University Graduate School of Medicine, Nagoya, Japan
Search for more papers by this authorMasahiro Sano
Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
Search for more papers by this authorYasuteru Sugino
Department of Respiratory Medicine, Toyota Memorial Hospital, Toyota, Japan
Search for more papers by this authorTetsuya Yagi
Department of Infectious Diseases, Nagoya University Hospital, Nagoya, Japan
Search for more papers by this authorHiroyuki Taniguchi
Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Japan
Search for more papers by this authorHideo Saka
Department of Respiratory Medicine, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
Search for more papers by this authorShigeyuki Matsui
Department of Biostatistics, Nagoya University Graduate School of Medicine, Nagoya, Japan
Search for more papers by this authorYoshinori Hasegawa
Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
Search for more papers by this authoron behalf of the Central Japan Lung Study Group
Search for more papers by this authorABSTRACT
Background and objective
Drug-resistant pathogen (DRP) risk stratification is important for choosing a treatment strategy for community-onset pneumonia. Evidence for benefits of non-antipseudomonal β-lactam plus macrolide combination therapy (BLM) on mortality is limited in patients at low DRP risk. Risk factors for mortality remain to be clarified.
Methods
Post hoc analysis using a prospective multicentre study cohort of community-onset pneumonia was performed to assess 30-day differences in mortality between non-antipseudomonal β-lactam monotherapy (BL) and BLM groups. Logistic regression analysis was performed to assess the therapeutic effect and risk factors for mortality in patients at low DRP risk.
Results
In total, 594 patients with community-onset pneumonia at low DRP risk (369 BL and 225 BLM) were analysed. The 30-day mortality in BL and BLM was 13.8% and 1.8%, respectively (P < 0.001). Multivariate analysis showed that BLM reduced the 30-day mortality (adjusted odds ratio: 0.28, 95% CI: 0.09–0.87) compared with BL. Independent prognostic factors for 30-day mortality included arterial partial pressure of carbon dioxide (PaCO2) > 50 mm Hg, white blood cell count < 4000/mm3, non-ambulatory status, albumin < 3.0 g/dL, haematocrit < 30%, age ≥ 80 years, respiratory rate > 25/min and body temperature < 36°C.
Conclusion
In patients with community-onset pneumonia at low DRP risk, BLM treatment reduced 30-day mortality compared with BL. Independent risk factors for mortality are potential confounding factors when assessing antibiotic effects in randomized clinical trials.
Supporting Information
| Filename | Description |
|---|---|
| resp13232-sup-0001-SuppInfo.docxWord 2007 document , 113.5 KB |
Figure S1 Patients with pathogens susceptible to β-lactam treatment. Table S1 Identified pathogens according to treatment groups. Table S2 Univariate analysis for 30-day morality in patients at low risk for CAP-DRPs. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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