title: The need for macrolides in hospitalised community-acquired pneumonia: propensity analysis.
abstract: The present study compared beta-lactam macrolide ("combination") therapy versus beta-lactam alone ("monotherapy") for hospitalised community-acquired pneumonia, using propensity scores to adjust for the differences between patients. A prospective multinational observational study was carried out. Baseline patient and infection characteristics were used to develop a propensity score for combination therapy. Patients were matched by the propensity score (three decimal point precision) and compared with 30-day mortality and hospital stay. The propensity score was used as a covariate in a logistic model for mortality. Patients treated with monotherapy (n = 169) were older (mean+/-sd age 70.6+/-17.3 versus 65.0+/-19.6 yrs), had a higher chronic diseases score and a different clinical presentation compared with patients treated with combination therapy (n = 282). Unadjusted mortality was significantly higher with monotherapy (37 (22%) out of 169 versus 21 (7%) out of 282). Only 27 patients in the monotherapy group could be matched to 27 patients in the combination group using the propensity score. The mortality in these groups was identical, with three (11%) demises each. The multivariable odds ratio for mortality associated with combination therapy, adjusted for the propensity score and the Pneumonia Severity Index, was 0.69 (95% confidence interval 0.32-1.48). The benefit of combination therapy versus monotherapy cannot be reliably assessed in observational studies, since the propensity to prescribe these regimens differs markedly.
authors.affiliation: Department of Medicine E, Rabin Medical Center, Beilinson Hospital, 49100 Petah-Tiqva, Israel.
authors.forename: M
authors.initials: M
authors.lastname: Paul
authors.forename: A D
authors.initials: AD
authors.lastname: Nielsen
authors.forename: A
authors.initials: A
authors.lastname: Gafter-Gvili
authors.forename: E
authors.initials: E
authors.lastname: Tacconelli
authors.forename: S
authors.initials: S
authors.lastname: Andreassen
authors.forename: N
authors.initials: N
authors.lastname: Almanasreh
authors.forename: E
authors.initials: E
authors.lastname: Goldberg
authors.forename: R
authors.initials: R
authors.lastname: Cauda
authors.forename: U
authors.initials: U
authors.lastname: Frank
authors.forename: L
authors.initials: L
authors.lastname: Leibovici
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000401:mortality; D003661:Decision Support Techniques; D004352:Drug Resistance, Microbial; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D018942:Macrolides / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000401:mortality; D011336:Probability; D011446:Prospective Studies; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000188:drug therapy / Q000401:mortality; D016019:Survival Analysis; D015996:Survival Rate; D047090:beta-Lactams / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D018942:Macrolides; D047090:beta-Lactams