ERJ
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH
QUICK SEARCH:   [advanced]


     

Published online before print February 2, 2006
Eur Respir J 2006, doi:10.1183/09031936.06.00126004
This Article
Right arrow Full Text (Rapid PDF)
Right arrow All Versions of this Article:
27/5/1010    most recent
09031936.06.00126004v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Permissions
Right arrowRequest Permissions
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Aspa, J.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Aspa, J.

ORIGINAL ARTICLE

Impact of initial antibiotic choice on mortality from pneumococcal pneumonia

J. Aspa 1*, O. Rajas 1, F.R. de Castro 2, M.C. Huertas 3, L. Borderías 4, F.J. Cabello 5, J. Tábara 6, S.H. Flix 7, A.M. Sanchis 8, A. Torres 9, The Pneumococcal Pneumonia in Spain Study Group 10

1 Hospital de La Princesa. Madrid.
2 Hospital Dr. Negrín. Gran Canaria.
3 Hospital Juan Ramón Jiménez. Huelva
4 Hospital San Jorge. Huesca
5 Hospital General Serranía de Ronda. Ronda. Málaga.
6 Hospital Cristal Piñor. Orense.
7 Hospital Sant Joan. Reus. Tarragona.
8 Hospital Marina Baixa. Villajoyosa. Alicante.
9 Hospital Clínic. Barcelona.
10 Grupo TIR. Sociedad Española de Neumología y Cirugía Torácica. SEPAR.

* To whom correspondence should be addressed. E-mail: jaspa{at}separ.es.


  Abstract

To determine the impact of initial antimicrobial choice on 30-day mortality-rate in patients with community-acquired pneumococcal pneumonia (CAP-SP), a prospective, observational study was conducted in 35 Spanish hospitals. Six hundred thirty-eight patients with CAP-SP were identified. Antimicrobials were chosen by the attending physician. Patients were grouped into the following categories: Beta-lactam-monotherapy (n=251); macrolide-monotherapy (n=37); Beta-lactam+macrolide (n=198); levofloxacin-alone/combination (n=48); and other combinations (n=104). The reference category was Beta-lactam+macrolide.

The 30-day survival probability was 84.9%. Using multivariable survival analysis, factors related to mortality in the entire population were: bilateral disease [Hazard ratio (HR):1.98]; suspected aspiration (HR:2.79); shock (HR:5.76); HIV infection (HR:2.06); renal failure (HR:1.86); and PSI score categories IV vs I-III (HR: 2.61) and categories V vs I-III (HR: 3.24). The association of {beta}-lactams+macrolides was not better than the use of {beta}-lactams alone. We also analyzed different groups of patients with significant mortality/morbidity: ICU, PSI class >III, renal failure, chronic lung disease and bacteremic patients. Only in patients with PSI class >III, the initial antimicrobial choice classified as "other combinations", was associated with higher mortality.

In conclusion, we have not demonstrated an independent association between initial antimicrobial regimen and 30-day mortality in CAP-SP-patients, except for those with higher PSI score.

Keywords:  Antimicrobial resistance, mortality, pneumococcal pneumonia, risk factors, Streptococcus pneumoniae




This article has been cited by other articles:


Home page
 J Antimicrob ChemotherHome page
A. Tessmer, T. Welte, P. Martus, M. Schnoor, R. Marre, and N. Suttorp
Impact of intravenous {beta}-lactam/macrolide versus {beta}-lactam monotherapy on mortality in hospitalized patients with community-acquired pneumonia
J. Antimicrob. Chemother., May 1, 2009; 63(5): 1025 - 1033.
[Abstract] [Full Text] [PDF]

Home page
 Eur Respir JHome page
M. Paul, A. D. Nielsen, A. Gafter-Gvili, E. Tacconelli, S. Andreassen, N. Almanasreh, E. Goldberg, R. Cauda, U. Frank, L. Leibovici, et al.
The need for macrolides in hospitalised community-acquired pneumonia: propensity analysis
Eur. Respir. J., September 1, 2007; 30(3): 525 - 531.
[Abstract] [Full Text] [PDF]

Home page
 JWatch GeneralHome page
Combination Antibiotic Therapy for Pneumococcal Pneumonia?
Journal Watch (General), July 18, 2006; 2006(718): 5 - 5.
[Full Text]

Home page
 JWatch Infect. DiseasesHome page
Combination Antibiotic Therapy for Pneumococcal Pneumonia?
Journal Watch Infectious Diseases, June 22, 2006; 2006(622): 4 - 4.
[Full Text]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH
Copyright © 2006 by the European Respiratory Society.