Skip to main content

Main menu

  • Home
  • Current issue
  • ERJ Early View
  • Past issues
  • For authors
    • Instructions for authors
    • Submit a manuscript
    • Author FAQs
    • Open access
    • COVID-19 submission information
  • Alerts
  • Podcasts
  • Subscriptions
  • ERS Publications
    • European Respiratory Journal
    • ERJ Open Research
    • European Respiratory Review
    • Breathe
    • ERS Books
    • ERS publications home

User menu

  • Log in
  • Subscribe
  • Contact Us
  • My Cart

Search

  • Advanced search
  • ERS Publications
    • European Respiratory Journal
    • ERJ Open Research
    • European Respiratory Review
    • Breathe
    • ERS Books
    • ERS publications home

Login

European Respiratory Society

Advanced Search

  • Home
  • Current issue
  • ERJ Early View
  • Past issues
  • For authors
    • Instructions for authors
    • Submit a manuscript
    • Author FAQs
    • Open access
    • COVID-19 submission information
  • Alerts
  • Podcasts
  • Subscriptions

Macrolide combination therapy for patients hospitalised with community-acquired pneumonia? An individualised approach supported by machine learning

Rainer König, Xueqi Cao, Marcus Oswald, Christina Forstner, Gernot Rohde, Jan Rupp, Martin Witzenrath, Tobias Welte, Martin Kolditz, Mathias Pletz for the CAPNETZ study group
European Respiratory Journal 2019 54: 1900824; DOI: 10.1183/13993003.00824-2019
Rainer König
1Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
2Network Modelling, Hans Knöll Institut Jena, Jena, Germany
12These authors contributed equally
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Rainer König
Xueqi Cao
1Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
2Network Modelling, Hans Knöll Institut Jena, Jena, Germany
12These authors contributed equally
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Marcus Oswald
1Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
2Network Modelling, Hans Knöll Institut Jena, Jena, Germany
12These authors contributed equally
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Christina Forstner
3Institute of Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
4Dept of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Gernot Rohde
5Dept of Respiratory Medicine, Medical Clinic I, Goethe University Hospital, Frankfurt/Main, Germany
6CAPNETZ STIFTUNG, Hannover Medical School, Hannover, Germany
7Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL)
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Jan Rupp
6CAPNETZ STIFTUNG, Hannover Medical School, Hannover, Germany
8Dept of Infectious Diseases and Microbiology, University-Hospital Schleswig-Holstein/Campus Lübeck, University of Lübeck, Lübeck, Germany
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Martin Witzenrath
6CAPNETZ STIFTUNG, Hannover Medical School, Hannover, Germany
9Division of Pulmonary Inflammation, and Dept of Infectious Diseases and Respiratory Medicine, Charité – Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Tobias Welte
6CAPNETZ STIFTUNG, Hannover Medical School, Hannover, Germany
10Dept of Respiratory Medicine, Hannover Medical School, Hannover, Germany
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Martin Kolditz
11Division of Pulmonology, Medical Dept I, University Hospital Carl Gustav Carus, Dresden, Germany
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Mathias Pletz
3Institute of Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
6CAPNETZ STIFTUNG, Hannover Medical School, Hannover, Germany
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Mathias Pletz
  • For correspondence: mathias.pletz@med.uni-jena.de
  • Article
  • Figures & Data
  • Info & Metrics
  • PDF
Loading

Abstract

Background The role of macrolide/β-lactam combination therapy in community-acquired pneumonia (CAP) of moderate severity is a matter of debate. Macrolides expand the coverage to atypical pathogens and attenuate pulmonary inflammation, but have been associated with cardiovascular toxicity and drug interactions. We developed a decision tree based on aetiological and clinical parameters, which are available ex ante to support a personalised decision for or against macrolides for the best clinical outcome of the individual patient.

Methods We employed machine learning in a cross-validation scheme based on a well-balanced selection of 4898 patients after propensity score matching to data available on admission of 6440 hospitalised patients with moderate severity (non-intensive care unit patients) from the observational, prospective, multinational CAPNETZ study. We aimed to improve the primary outcome of 180-day survival.

Results We found a simple decision tree of patient characteristics comprising chronic cardiovascular and chronic respiratory comorbidities as well as leukocyte counts in the respiratory secretion at enrolment. Specifically, we found that patients without cardiovascular or patients with respiratory comorbidities and high leukocyte counts in the respiratory secretion benefit from macrolide treatment. Patients identified to be treated in compliance with our treatment suggestion had a lower mortality of 27% (OR 1.83, 95% CI 1.48–2.27; p<0.001) compared to the observed standard of care.

Conclusion Stratifying macrolide treatment in patients following a simple treatment rule may lead to considerably reduced mortality in CAP. A future randomised controlled trial confirming our result is necessary before implementing this rule into the clinical routine.

Abstract

A simple decision tree distinguishes patients who benefit from macrolides from those who are harmed. In our model, the rule can lower mortality by 30% in hospitalised CAP patients with moderate disease. However, prospective evaluation is required. http://bit.ly/2kG5xA5

Footnotes

  • This article has supplementary material available from erj.ersjournals.com

  • This study is registered at www.drks.de with identifier number DRKS00005274.

  • Members of the CAPNETZ study group are: M. Dreher, C. Cornelissen (Aachen); W. Knüppel (Bad Arolsen); D. Stolz (Basel); N. Suttorp, M. Witzenrath, P. Creutz, A. Mikolajewska (Berlin, Charité); T. Bauer, D. Krieger (Berlin); W. Pankow, D. Thiemig (Berlin-Neukölln); B. Hauptmeier, S. Ewig, D. Wehde (Bochum); M. Prediger, S. Schmager (Cottbus); M. Kolditz, B. Schulte-Hubbert, S. Langner (Dresden); W. Albrich (St Gallen); T. Welte, J. Freise, G. Barten, O. Arenas Toro, M. Nawrocki, J. Naim, M. Witte, W. Kröner, T. Illig, N. Klopp (Hannover); M. Kreuter, F. Herth, S. Hummler (Heidelberg); P. Ravn, A. Vestergaard-Jensen, G. Baunbaek-Knudsen (Hillerød); M. Pletz, C. Kroegel, J. Frosinski, J. Winning, B. Schleenvoigt (Jena); K. Dalhoff, J. Rupp, R. Hörster, D. Drömann (Lübeck); G. Rohde, J. Drijkoningen, D. Braeken (Maastricht); H. Buschmann (Paderborn); T. Schaberg, I. Hering (Rotenburg/Wümme); M. Panning (Freiburg); M. Wallner (Ulm).

  • Support statement: This work was supported by the project CSCC (01EO1002, 01EO1502) of the German Federal Ministry of Education and Research (BMBF), the project CancerTelSys (01ZX1302B, 01ZX1602B) in the e:Med programme and the project KO 3678/5-1 funded by the Deutsche Forschungsgemeinschaft (DFG). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. Funding information for this article has been deposited with the Crossref Funder Registry.

  • Conflict of interest: None declared.

  • Received April 25, 2019.
  • Accepted September 5, 2019.
  • Copyright ©ERS 2019
https://www.ersjournals.com/user-licence
View Full Text

ERS Members

myERS - ERS members : log in with your myERS username and password.

INDIVIDUALS

Log in Login as an individual user.

Forgot your username or password?

LIBRARY USERS

Log in through your institution

If your library has a subscription, you may already be logged in via your IP address. Otherwise you may be able to log in via one of the following routes.
You may be able to gain access using your login credentials for your institution. Contact your library if you do not have a username and password.
If your organization uses OpenAthens, you can log in using your OpenAthens username and password. To check if your institution is supported, please see this list. Contact your library for more details.
If you think you should have access, please contact your librarian or email journals@ersnet.org

Purchase access

You may purchase access to this article. This will require you to create an account if you don't already have one.
PreviousNext
Back to top
View this article with LENS
Vol 54 Issue 6 Table of Contents
European Respiratory Journal: 54 (6)
  • Table of Contents
  • Index by author
Email

Thank you for your interest in spreading the word on European Respiratory Society .

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Macrolide combination therapy for patients hospitalised with community-acquired pneumonia? An individualised approach supported by machine learning
(Your Name) has sent you a message from European Respiratory Society
(Your Name) thought you would like to see the European Respiratory Society web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Print
Alerts
Sign In to Email Alerts with your Email Address
Citation Tools
Macrolide combination therapy for patients hospitalised with community-acquired pneumonia? An individualised approach supported by machine learning
Rainer König, Xueqi Cao, Marcus Oswald, Christina Forstner, Gernot Rohde, Jan Rupp, Martin Witzenrath, Tobias Welte, Martin Kolditz, Mathias Pletz
European Respiratory Journal Dec 2019, 54 (6) 1900824; DOI: 10.1183/13993003.00824-2019

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero

Share
Macrolide combination therapy for patients hospitalised with community-acquired pneumonia? An individualised approach supported by machine learning
Rainer König, Xueqi Cao, Marcus Oswald, Christina Forstner, Gernot Rohde, Jan Rupp, Martin Witzenrath, Tobias Welte, Martin Kolditz, Mathias Pletz
European Respiratory Journal Dec 2019, 54 (6) 1900824; DOI: 10.1183/13993003.00824-2019
del.icio.us logo Digg logo Reddit logo Technorati logo Twitter logo CiteULike logo Connotea logo Facebook logo Google logo Mendeley logo
Full Text (PDF)

Jump To

  • Article
    • Abstract
    • Abstract
    • Introduction
    • Methods
    • Results
    • Discussion
    • Supplementary material
    • Shareable PDF
    • Acknowledgements
    • Footnotes
    • References
  • Figures & Data
  • Info & Metrics
  • PDF
  • Tweet Widget
  • Facebook Like
  • Google Plus One

More in this TOC Section

Original Articles

  • Allergen inhalation associated with airway dysfunction
  • OSTEOPOROSIS AND FACTURE RISK ASSOCIATED WITH ICS USE IN COPD
  • Cost-effectiveness of azithromycin in reducing asthma exacerbations
Show more Original Articles

Pneumonia

  • pneumonia
  • pneumonia
Show more Pneumonia

Related Articles

Navigate

  • Home
  • Current issue
  • Archive

About the ERJ

  • Journal information
  • Editorial board
  • Reviewers
  • CME
  • Press
  • Permissions and reprints
  • Advertising

The European Respiratory Society

  • Society home
  • myERS
  • Privacy policy
  • Accessibility

ERS publications

  • European Respiratory Journal
  • ERJ Open Research
  • European Respiratory Review
  • Breathe
  • ERS books online
  • ERS Bookshop

Help

  • Feedback

For authors

  • Instructions for authors
  • Submit a manuscript
  • ERS author centre

For readers

  • Alerts
  • Subjects
  • Podcasts
  • RSS

Subscriptions

  • Accessing the ERS publications

Contact us

European Respiratory Society
442 Glossop Road
Sheffield S10 2PX
United Kingdom
Tel: +44 114 2672860
Email: journals@ersnet.org

ISSN

Print ISSN:  0903-1936
Online ISSN: 1399-3003

Copyright © 2021 by the European Respiratory Society