JAC Advance Access originally published online on March 17, 2009
Journal of Antimicrobial Chemotherapy 2009 63(5):1025-1033; doi:10.1093/jac/dkp088
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Original research |
Impact of intravenous β-lactam/macrolide versus β-lactam monotherapy on mortality in hospitalized patients with community-acquired pneumonia
1 Department of Infectious Disease and Respiratory Medicine, Charité-University Medicine, Berlin, Germany 2 Department of Pulmonary Medicine, Medical University Hannover, Hannover, Germany 3 Department of Biometry and Clinical Epidemiology, Charité-University Medicine, Berlin, Germany 4 Institute of Social Medicine, Medical University Schleswig-Holstein, Campus Luebeck, Germany 5 Department of Medical Microbiology and Hygiene, University of Ulm, Germany
Received 2 November 2008; returned 29 November 2008; revised 18 February 2009; accepted 21 February 2009
* Corresponding author. Medical Department of Infectious Disease and Respiratory Medicine, Charité-University Medicine Berlin, Campus Virchow Klinikum and Campus Mitte, Augustenburger Platz 1, 13353 Berlin, Germany. Tel: +49-30-653326; Fax: +49-30-553906; E-mail: antje.tessmer{at}charite.de
Objectives: Guidelines recommend dual-therapy consisting of a β-lactam/macrolide (BLM) for hospitalized patients with community-acquired pneumonia. Nevertheless, the superiority over β-lactam-monotherapy (BL) remains unproven.
Methods: Analyses from an observational study initiated by the German competence network CAPNETZ were performed.
Results: One thousand eight hundred and fifty-four patients were treated with either BL (49.0%) or BLM (51.0%). BLM therapy was associated with lower adjusted 14 day mortality [odds ratio (OR) 0.53; 95% confidence interval (CI): 0.30–0.94]. CRB65, neoplastic disease, age and nursing home residency were confirmed as independent predictors of death. Adjusted 14 day mortality risk was clearly reduced in patients with CRB65 = 2 (n = 411; OR 0.35; CI: 0.12–0.99) and CRB65 
2 (n = 519; OR 0.42; CI: 0.18–0.997). However, this could not be shown for adjusted 30 day mortality. Patients with CRB65 
1 showed low mortality (2.1%) without the influence of BLM. BLM therapy was associated with lower adjusted risk of treatment failure at 14 days (n = 1854; OR 0.65; CI: 0.47–0.89) and 30 days (OR 0.69; CI: 0.51–0.94) as well as in the subgroup of patients with CRB65 = 2 and CRB65 2.
Conclusions: This study suggests the superiority of BLM therapy in patients with CRB65 risk classes of 2 or higher on 14 day mortality. BLM therapy was also associated with lower risk of treatment failure.
Keywords: antibiotic therapy , community-acquired infection , treatment failure