Journal article
Comparison of two guideline-concordant antimicrobial combinations in elderly patients hospitalized with severe community-acquired pneumonia
Critical care medicine, Vol.40(8), pp.2310-2314
08/01/2012
DOI: 10.1097/CCM.0b013e31825151a8
PMCID: PMC4066649
PMID: 22622401
Abstract
Objective: Two of the guideline-concordant therapies for severe community-acquired pneumonia are either a beta-lactam and fluoroquinolone or beta-lactam and macrolide. However it is unclear if there is a benefit for one vs. the other for elderly patients with severe community-acquired pneumonia.
Design: A retrospective population-based cohort study of patients with community-acquired pneumonia.
Setting: Patients admitted to an intensive care unit of any Department of Veterans Affairs hospital during 5-yr period.
Patients: We included only those patients >65 yrs of age admitted to the intensive care unit with community-acquired pneumonia who received either beta-lactam +fluoroquinolone or beta-lactam + macrolide antibiotic therapy for pneumonia.
Intervention: Not applicable.
Measurements: We used multilevel regression models to examine the effect of beta-lactam + fluoroquinolone vs. beta-lactam + macrolide on each of the outcomes after adjusting for potential confounders using propensity scores.
Main Results: The cohort consisted of 1,989 patients: 98.5% male and a mean age of 74 yrs. For treatment, 44% of subjects received beta-lactam + fluoroquinolone and 56% received beta-lactam + macrolide. Unadjusted 30-day mortality was 27% for beta-lactam + fluoroquinolone and 24% for beta-lactam + macrolide (p = .11). In the multilevel models, the use of beta-lactam + fluoroquinolone was not significantly associated with 30-day mortality (odds ratio 1.05, 95% confidence interval 0.85-1.30). However, the use of beta-lactam + fluoroquinolone was significantly associated with increased mean length of stay (incidence rate ratio 1.30, 95% confidence interval 1.27-1.33).
Conclusions: We found no significant difference for 30-day mortality but did demonstrate an association with increase in length of stay associated with the use of beta-lactam + fluoroquinolone. Randomized controlled trials are needed to determine the most effective antibiotics regimes for patients with severe pneumonia. (Crit Care Med 2012; 40:2310-2314)
Details
- Title: Subtitle
- Comparison of two guideline-concordant antimicrobial combinations in elderly patients hospitalized with severe community-acquired pneumonia
- Creators
- Bryan Z. Wilson - VA Medical CenterAntonio Anzueto - VA Medical CenterMarcos I. Restrepo - VA Medical CenterMary Jo V. Pugh - The University of Texas at San AntonioEric M. Mortensen - Society of Hospital Medicine
- Resource Type
- Journal article
- Publication Details
- Critical care medicine, Vol.40(8), pp.2310-2314
- DOI
- 10.1097/CCM.0b013e31825151a8
- PMID
- 22622401
- PMCID
- PMC4066649
- NLM abbreviation
- Crit Care Med
- ISSN
- 0090-3493
- eISSN
- 1530-0293
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 5
- Grant note
- K23HL096054 / National Institute of Health; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA R01NR010828 / National Institute of Nursing Research; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Nursing Research (NINR) K23HL096054 / National Heart, Lung, and Blood Institute; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Heart Lung & Blood Institute (NHLBI)
- Language
- English
- Date published
- 08/01/2012
- Academic Unit
- Emergency Medicine
- Record Identifier
- 9984297354602771
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