The need for macrolides in hospitalised community-acquired pneumonia: propensity analysis

¹ Dept of Medicine E, Rabin Medical Center, Beilinson Campus; and Sackler Faculty of Medicine, Tel-Aviv University, Israel
² University Center for Model-based Medical Decision Support, Aalborg University, Denmark
³ Dept of Infectious Diseases, Gemelli Hospital in Rome. Universitá Cattolica del Sacro Cuore School of Medicine, Italy
⁴ Dept of Clinical Microbiology and Hospital Hygiene, Freiburg University Hospital. Freiburg, Germany

^* To whom correspondence should be addressed. E-mail: leibovic{at}post.tau.ac.il.

	Abstract

We compared beta-lactam-macrolide ("combination") therapy vs. beta-lactam alone ("monotherapy") for hospitalised community-acquired pneumonia, using propensity scores to adjust for the differences between patients.

Prospective multinational observational study. Baseline patient and infection characteristics were used to develop a propensity score for combination therapy. We matched patients by the propensity score (3 decimal point precision) and compared 30-day mortality and hospital stay. We used the propensity score as a covariate in a logistic model for mortality.

Patients treated with monotherapy (N=169) were older (mean age 70.6±17.3 vs. 65.0±19.6 years) had a higher chronic diseases score and a different clinical presentation compared to patients given combination therapy (N=282). Unadjusted mortality was significantly higher with monotherapy (37/169, 22% vs. 21/282, 7%). Only 27 patients in the monotherapy group could be matched to 27 patients in the combination group using the propensity score. The mortality in these groups was identical, 3 (11%) demises each. The multivariable odds ratio for mortality associated with combination therapy, adjusted for the propensity score and the Pneumonia Severity Index, was 0.69, 95% CI 0.32-1.48.

The benefit of combination vs. monotherapy cannot be reliably assessed in observational studies, since the propensity to prescribe these regimens differs markedly.

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