title: Severe pneumococcal pneumonia: impact of new quinolones on prognosis.
abstract: BACKGROUND
  Most guidelines have been proposing, for more than 15 years, a β-lactam combined with either a quinolone or a macrolide as empirical, first-line therapy of severe community acquired pneumonia (CAP) requiring ICU admission. Our goal was to evaluate the outcome of patients with severe CAP, focusing on the impact of new rather than old fluoroquinolones combined with β-lactam in the empirical antimicrobial treatments.
  
  
  METHODS
  Retrospective study of consecutive patients admitted in a 16-bed general intensive care unit (ICU), between January 1996 and January 2009, for severe (Pneumonia Severity Index > or = 4) community-acquired pneumonia due to non penicillin-resistant Streptococcus pneumoniae and treated with a β-lactam combined with a fluoroquinolone.
  
  
  RESULTS
  We included 70 patients of whom 38 received a β-lactam combined with ofloxacin or ciprofloxacin and 32 combined with levofloxacin. Twenty six patients (37.1%) died in the ICU. Three independent factors associated with decreased survival in ICU were identified: septic shock on ICU admission (AOR = 10.6; 95% CI 2.87-39.3; p = 0.0004), age > 70 yrs. (AOR = 4.88; 95% CI 1.41-16.9; p = 0.01) and initial treatment with a β-lactam combined with ofloxacin or ciprofloxacin (AOR = 4.1; 95% CI 1.13-15.13; p = 0.03).
  
  
  CONCLUSIONS
  Our results suggest that, when combined to a β-lactam, levofloxacin is associated with lower mortality than ofloxacin or ciprofloxacin in severe pneumococcal community-acquired pneumonia.
authors.affiliation: Service de Réanimation Médicale et Maladies Infectieuses, Hôpital Chatiliez, Tourcoing 59, France.
authors.forename: David
authors.initials: D
authors.lastname: Olive
authors.forename: Hugues
authors.initials: H
authors.lastname: Georges
authors.forename: Patrick
authors.initials: P
authors.lastname: Devos
authors.forename: Nicolas
authors.initials: N
authors.lastname: Boussekey
authors.forename: Arnaud
authors.initials: A
authors.lastname: Chiche
authors.forename: Agnes
authors.initials: A
authors.lastname: Meybeck
authors.forename: Serge
authors.initials: S
authors.lastname: Alfandari
authors.forename: Olivier
authors.initials: O
authors.lastname: Leroy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011018:Pneumonia, Pneumococcal / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology*; D011379:Prognosis; D015363:Quinolones / Q000627:therapeutic use*; D012189:Retrospective Studies; D013296:Streptococcus pneumoniae / Q000187:drug effects; D016896:Treatment Outcome; D047090:beta-Lactams / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D015363:Quinolones; D047090:beta-Lactams