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Published on: February 23, 2014

Impact of initial antibiotic choice on mortality from pneumococcal pneumonia

J Aspa1, O Rajas, F Rodriguez de Castro

  • 1Hospital de La Princesa, Madrid, Spain. jaspa@separ.es

The European Respiratory Journal
|February 4, 2006
PubMed

Insights

Initial antibiotic choice did not significantly impact 30-day mortality for community-acquired pneumococcal pneumonia (CAP-SP). However, certain patient groups, like those with higher pneumonia severity index (PSI) scores, showed increased mortality with specific antimicrobial combinations.

Area of Science:

  • Infectious Diseases
  • Clinical Medicine
  • Pharmacology

Background:

  • Community-acquired pneumonia (CAP) caused by Streptococcus pneumoniae (CAP-SP) remains a significant cause of mortality.
  • The optimal initial antimicrobial regimen for CAP-SP is crucial for patient outcomes.
  • Previous studies have suggested varying efficacies of different antibiotic classes.

Purpose of the Study:

  • To evaluate the impact of initial antimicrobial selection on 30-day mortality in patients with CAP-SP.
  • To identify factors associated with mortality in CAP-SP patients.
  • To determine if specific antimicrobial regimens offer survival advantages.

Main Methods:

  • A prospective, observational study involving 638 patients with CAP-SP across 35 Spanish hospitals.
  • Patients were categorized based on their initial antimicrobial treatment (beta-lactam monotherapy, macrolide monotherapy, beta-lactam plus macrolide, levofloxacin, other combinations).
  • Multivariate survival analysis was used to assess mortality risk factors and treatment associations.

Main Results:

  • The overall 30-day survival probability was 84.9%.
  • Factors independently associated with mortality included bilateral disease, shock, HIV infection, renal failure, and higher Pneumonia Severity Index (PSI) scores.
  • No significant difference in mortality was observed between beta-lactam monotherapy and beta-lactam plus macrolide regimens. Beta-lactam monotherapy was not worse than beta-lactam plus macrolide.
  • Only patients with PSI Class >III receiving 'other combinations' of antimicrobials showed higher mortality.

Conclusions:

  • The initial antimicrobial regimen does not appear to be an independent predictor of 30-day mortality in most CAP-SP patients.
  • Higher PSI scores are a critical factor influencing mortality risk, particularly when combined with 'other' antimicrobial choices.
  • Clinical decisions on antimicrobial therapy should consider patient-specific factors, especially severity of illness (PSI score).

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