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01.04.2010 | Original

Combination antibiotic therapy with macrolides improves survival in intubated patients with community-acquired pneumonia

verfasst von: I. Martin-Loeches, T. Lisboa, A. Rodriguez, C. Putensen, D. Annane, J. Garnacho-Montero, M. I. Restrepo, J. Rello

Erschienen in: Intensive Care Medicine | Ausgabe 4/2010

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Abstract

Objective

To assess the effect on survival of macrolides or fluoroquinolones in intubated patients admitted to the intensive care unit (ICU) with severe community-acquired pneumonia (severe CAP).

Methods

Prospective, observational cohort, multicenter study conducted in 27 ICUs of 9 European countries. Two hundred eighteen consecutive patients requiring invasive mechanical ventilation for an admission diagnosis of CAP were recruited.

Results

Severe sepsis and septic shock were present in 165 (75.7%) patients. Microbiological documentation was obtained in 102 (46.8%) patients. ICU mortality was 37.6% (n = 82). Non-survivors were older (58.6 ± 16.1 vs. 63.4 ± 16.7 years, P < 0.05) and presented a higher score on the simplified Acute Physiology Score II at admission (45.6 ± 15.4 vs. 50.8 ± 17.5, P < 0.05). Monotherapy was given in 43 (19.7%) and combination therapy in 175 (80.3%) patients. Empirical antibiotic therapy was in accordance with the 2007 Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) guidelines in 100 (45.9%) patients (macrolides in 46 patients and fluoroquinolones in 54). In this cohort, a Cox regression analysis adjusted by severity identified that macrolide use was associated with lower ICU mortality (hazard ratio, HR 0.48, confidence intervals, 95% CI 0.23–0.97, P = 0.04) when compared to the use of fluoroquinolones. When more severe patients presenting severe sepsis and septic shock were analyzed (n = 92), similar results were obtained (HR 0.44, 95% CI 0.20–0.95, P = 0.03).

Conclusions

Patients with severe community-acquired pneumonia had a low adherence with the 2007 IDSA/ATS guidelines. Combination therapy with macrolides should be preferred in intubated patients with severe CAP.

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Titel: Combination antibiotic therapy with macrolides improves survival in intubated patients with community-acquired pneumonia
verfasst von: I. Martin-Loeches
T. Lisboa
A. Rodriguez
C. Putensen
D. Annane
J. Garnacho-Montero
M. I. Restrepo
J. Rello
Publikationsdatum: 01.04.2010
Verlag: Springer-Verlag
Erschienen in: Intensive Care Medicine / Ausgabe 4/2010
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-009-1730-y

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Combination antibiotic therapy with macrolides improves survival in intubated patients with community-acquired pneumonia