Beta-Lactam Plus Macrolide for Patients Hospitalized With Community-Acquired Pneumonia: Difference Between Autumn and
Yoonjung Kim1, Yena Jeon2, Ki Tae Kwon3
1Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea.
Background:
The 2017 Korean guideline on community-acquired pneumonia (CAP) recommended beta-lactam plus macrolide combination therapy for patients hospitalized with severe pneumonia, and beta-lactam monotherapy for mild-to-moderate pneumonia. However, antibiotic treatment regimen for mild-to-moderate CAP has never been evaluated for Korean patients.
Methods:
In this retrospective cohort study, study patients were selected from three evaluation periods (October 1 to December 31, 2014; April 1 to June 30, 2016; October 1 to December 31, 2017) of the National Quality Assessment Program for CAP management and the National Health Insurance data on the selected patients was extracted from 1 year before the first patient enrollment and 1 year after the last patient enrollment at each evaluation period for the analysis of risk adjustment and outcomes. The survival rates between beta-lactam plus macrolide (BM) groups and beta-lactam monotherapy (B) were compared using a Kaplan-Meier survival analysis after propensity score matching by age, gender, confusion, urea, respiratory rate, blood pressure at age of 65 years or older (CURB-65), and Charlson comorbidity index for risk adjustment. The differences between autumn and spring season were also evaluated.
Results:
A total of 30,053 patients were enrolled. Mean age and the male-to-female ratio were 64.7 ± 18.4 and 14,197:15,856, respectively. After matching, 2,397 patients in each group were analyzed. The 30-day survival rates did not differ between the BM and B groups (97.3% vs. 96.5%, P = 0.081). In patients with CURB-65 ≥ 2, the 30-day survival rate was higher in the BM than in the B group (93.7% vs. 91.0%, P = 0.044). Among patients with CURB-65 ≥ 2, the 30-day survival rate was higher in the BM than in the B group (93.3% vs. 88.5%, P = 0.009) during autumn season, which was not observed during spring (94.2% vs. 94.1%, P = 0.986).
Conclusion:
Beta-lactam plus macrolide combination therapy shows potential as an empirical therapy for CAP with CURB-65 ≥ 2, especially in autumn.
Insights
Beta-lactam plus macrolide combination therapy may improve survival for community-acquired pneumonia (CAP) patients with a CURB-65 score of 2 or higher, particularly during autumn. This finding offers valuable insights for empirical CAP treatment strategies.
Area of Science:
- Infectious Diseases
- Pulmonology
- Pharmacology
Background:
- The 2017 Korean guideline for community-acquired pneumonia (CAP) suggests specific antibiotic regimens based on severity.
- However, the efficacy of these recommendations for mild-to-moderate CAP in Korean patients remains unevaluated.
Purpose of the Study:
- To evaluate the effectiveness of beta-lactam plus macrolide combination therapy versus beta-lactam monotherapy for community-acquired pneumonia (CAP) in Korean patients.
- To assess the impact of CURB-65 severity score and season on treatment outcomes.
Main Methods:
- Retrospective cohort study using National Quality Assessment Program data (2014-2017) and National Health Insurance data.
- Propensity score matching was employed to compare 30-day survival rates between beta-lactam plus macrolide (BM) and beta-lactam monotherapy (B) groups.
- Analysis included risk adjustment using CURB-65 and Charlson comorbidity index, and seasonal variations were examined.
Main Results:
- No significant difference in 30-day survival was observed between BM and B groups overall (97.3% vs. 96.5%).
- In patients with CURB-65 score ≥ 2, the BM group showed a higher 30-day survival rate (93.7% vs. 91.0%, P=0.044).
- This survival benefit for the BM group in patients with CURB-65 ≥ 2 was significant during autumn (93.3% vs. 88.5%, P=0.009) but not spring (94.2% vs. 94.1%, P=0.986).
Conclusions:
- Beta-lactam plus macrolide combination therapy demonstrates potential as an empirical treatment for CAP in patients with a CURB-65 score of 2 or higher.
- The seasonal effect suggests this combination therapy may be particularly beneficial during the autumn season for this patient subgroup.
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