title: Addition of a macrolide to a beta-lactam-based empirical antibiotic regimen is associated with lower in-hospital mortality for patients with bacteremic pneumococcal pneumonia.
abstract: To assess the association between inclusion of a macrolide in a beta-lactam-based empirical antibiotic regimen and mortality among patients with bacteremic pneumococcal pneumonia, 10 years of data from a database were analyzed. The total available set of putative prognostic factors was subjected to stepwise logistic regression, with in-hospital death as the dependent variable. Of the 409 patients analyzed, 238 (58%) received a beta-lactam plus a macrolide and 171 (42%) received a beta-lactam without a macrolide. Multivariate analysis revealed 4 variables to be independently associated with death: shock (P<.0001), age of >or=65 years (P=.02), infections with pathogens that have resistance to both penicillin and erythromycin (P=.04), and no inclusion of a macrolide in the initial antibiotic regimen (P=.03). For patients with bacteremic pneumococcal pneumonia, not adding a macrolide to a beta-lactam-based initial antibiotic regimen is an independent predictor of in-hospital mortality. However, only a randomized study can definitively determine whether this association is due to a real effect of macrolides.
authors.affiliation: Institut Clínic Infeccions i Immunologia, Hospital Clinic Universitari, Barcelona, Spain. jamarti@clinic.ub.es
authors.forename: José A
authors.initials: JA
authors.lastname: Martínez
authors.forename: Juan P
authors.initials: JP
authors.lastname: Horcajada
authors.forename: Manuel
authors.initials: M
authors.lastname: Almela
authors.forename: Francesc
authors.initials: F
authors.lastname: Marco
authors.forename: Alex
authors.initials: A
authors.lastname: Soriano
authors.forename: Elisa
authors.initials: E
authors.lastname: García
authors.forename: Maria Angeles
authors.initials: MA
authors.lastname: Marco
authors.forename: Antoni
authors.initials: A
authors.lastname: Torres
authors.forename: Josep
authors.initials: J
authors.lastname: Mensa
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000401:mortality; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018942:Macrolides; D008297:Male; D008875:Middle Aged; D009026:Mortality; D015999:Multivariate Analysis; D011018:Pneumonia, Pneumococcal / Q000188:drug therapy* / Q000401:mortality; D012189:Retrospective Studies; D016896:Treatment Outcome; D047090:beta-Lactams
chemical_list: D000900:Anti-Bacterial Agents; D018942:Macrolides; D047090:beta-Lactams