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Addition of a macrolide to a ss-lactam in bacteremic pneumococcal pneumonia

R Dwyer1, A Ortqvist, E Aufwerber

  • 1Department of Medicine, Infectious Disease Unit, Karolinska University Hospital, 14186 Stockholm, Sweden. richard.dwyer@karolinska.se

European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology
|August 10, 2006
PubMed

Insights

This study found that adding a macrolide to beta-lactam therapy for bacteremic pneumococcal community-acquired pneumonia (CAP) did not significantly reduce the case fatality rate. Key predictors of death included older age and disease severity.

Area of Science:

  • Infectious Diseases
  • Pulmonology
  • Pharmacology

Background:

  • Bacteremic pneumococcal community-acquired pneumonia (CAP) is a serious condition.
  • Antimicrobial therapy is crucial for managing CAP.
  • The combination of beta-lactam and macrolide antibiotics is a common treatment strategy.

Purpose of the Study:

  • To retrospectively evaluate the efficacy of beta-lactam plus macrolide combination therapy for bacteremic pneumococcal CAP.
  • To identify predictors of mortality in patients with bacteremic pneumococcal CAP.

Main Methods:

  • Retrospective analysis of prospectively collected data from 340 adult patients across five countries.
  • Patients were hospitalized with bacteremic pneumococcal CAP and treated with a beta-lactam +/- macrolide.
  • Univariate and multivariate regression analyses were performed.

Main Results:

  • No significant effect on case fatality rate was observed with the macrolide/beta-lactam regimen as initial therapy.
  • Results remained consistent regardless of illness severity or exclusion of early deaths.
  • Predictors of death included age >65 years (OR=2.6), involvement of two or more lung lobes (OR=2.2), and high acute physiology score (APS > 8).

Conclusions:

  • The addition of a macrolide to beta-lactam therapy does not appear to significantly improve outcomes for bacteremic pneumococcal CAP.
  • Age, extent of lung involvement, and disease severity are significant predictors of mortality.

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