Abstract
OBJECTIVE: Two of the guideline-concordant therapies for severe community-acquired pneumonia are either a beta-lactam and fluoroquinolone or beta-lactam and macrolide. However it is unclear if there is a benefit for one vs. The other for elderly patients with severe community-acquired pneumonia. DESIGN: A retrospective population-based cohort study of patients with community-acquired pneumonia. SETTING: Patients admitted to an intensive care unit of any Department of Veterans Affairs hospital during 5-yr period. PATIENTS: We included only those patients >65 yrs of age admitted to the intensive care unit with community-acquired pneumonia who received either beta-lactam + fluoroquinolone or beta-lactam + macrolide antibiotic therapy for pneumonia. INTERVENTION: Not applicable. MEASUREMENTS: We used multilevel regression models to examine the effect of beta-lactam + fluoroquinolone vs. beta-lactam + macrolide on each of the outcomes after adjusting for potential confounders using propensity scores. MAIN RESULTS: The cohort consisted of 1,989 patients: 98.5% male and a mean age of 74 yrs. For treatment, 44% of subjects received beta-lactam + fluoroquinolone and 56% received beta-lactam + macrolide. Unadjusted 30-day mortality was 27% for beta-lactam + fluoroquinolone and 24% for beta-lactam + macrolide (p = .11). In the multilevel models, the use of beta-lactam + fluoroquinolone was not significantly associated with 30-day mortality (odds ratio 1.05, 95% confidence interval 0.85-1.30). However, the use of beta-lactam + fluoroquinolone was significantly associated with increased mean length of stay (incidence rate ratio 1.30, 95% confidence interval 1.27-1.33). CONCLUSIONS: We found no significant difference for 30-day mortality but did demonstrate an association with increase in length of stay associated with the use of beta-lactam + fluoroquinolone. Randomized controlled trials are needed to determine the most effective antibiotics regimes for patients with severe pneumonia.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 2310-2314 |
| Number of pages | 5 |
| Journal | Critical Care Medicine |
| Volume | 40 |
| Issue number | 8 |
| DOIs | |
| State | Published - Aug 2012 |
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ASJC Scopus subject areas
- Critical Care and Intensive Care Medicine
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Comparison of two guideline-concordant antimicrobial combinations in elderly patients hospitalized with severe community-acquired pneumonia. / Wilson, Bryan Z.; Anzueto, Antonio; Restrepo, Marcos I.; Pugh, Mary Jo V; Mortensen, Eric M.
In: Critical Care Medicine, Vol. 40, No. 8, 08.2012, p. 2310-2314.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Comparison of two guideline-concordant antimicrobial combinations in elderly patients hospitalized with severe community-acquired pneumonia
AU - Wilson, Bryan Z.
AU - Anzueto, Antonio
AU - Restrepo, Marcos I.
AU - Pugh, Mary Jo V
AU - Mortensen, Eric M.
PY - 2012/8
Y1 - 2012/8
N2 - OBJECTIVE: Two of the guideline-concordant therapies for severe community-acquired pneumonia are either a beta-lactam and fluoroquinolone or beta-lactam and macrolide. However it is unclear if there is a benefit for one vs. The other for elderly patients with severe community-acquired pneumonia. DESIGN: A retrospective population-based cohort study of patients with community-acquired pneumonia. SETTING: Patients admitted to an intensive care unit of any Department of Veterans Affairs hospital during 5-yr period. PATIENTS: We included only those patients >65 yrs of age admitted to the intensive care unit with community-acquired pneumonia who received either beta-lactam + fluoroquinolone or beta-lactam + macrolide antibiotic therapy for pneumonia. INTERVENTION: Not applicable. MEASUREMENTS: We used multilevel regression models to examine the effect of beta-lactam + fluoroquinolone vs. beta-lactam + macrolide on each of the outcomes after adjusting for potential confounders using propensity scores. MAIN RESULTS: The cohort consisted of 1,989 patients: 98.5% male and a mean age of 74 yrs. For treatment, 44% of subjects received beta-lactam + fluoroquinolone and 56% received beta-lactam + macrolide. Unadjusted 30-day mortality was 27% for beta-lactam + fluoroquinolone and 24% for beta-lactam + macrolide (p = .11). In the multilevel models, the use of beta-lactam + fluoroquinolone was not significantly associated with 30-day mortality (odds ratio 1.05, 95% confidence interval 0.85-1.30). However, the use of beta-lactam + fluoroquinolone was significantly associated with increased mean length of stay (incidence rate ratio 1.30, 95% confidence interval 1.27-1.33). CONCLUSIONS: We found no significant difference for 30-day mortality but did demonstrate an association with increase in length of stay associated with the use of beta-lactam + fluoroquinolone. Randomized controlled trials are needed to determine the most effective antibiotics regimes for patients with severe pneumonia.
AB - OBJECTIVE: Two of the guideline-concordant therapies for severe community-acquired pneumonia are either a beta-lactam and fluoroquinolone or beta-lactam and macrolide. However it is unclear if there is a benefit for one vs. The other for elderly patients with severe community-acquired pneumonia. DESIGN: A retrospective population-based cohort study of patients with community-acquired pneumonia. SETTING: Patients admitted to an intensive care unit of any Department of Veterans Affairs hospital during 5-yr period. PATIENTS: We included only those patients >65 yrs of age admitted to the intensive care unit with community-acquired pneumonia who received either beta-lactam + fluoroquinolone or beta-lactam + macrolide antibiotic therapy for pneumonia. INTERVENTION: Not applicable. MEASUREMENTS: We used multilevel regression models to examine the effect of beta-lactam + fluoroquinolone vs. beta-lactam + macrolide on each of the outcomes after adjusting for potential confounders using propensity scores. MAIN RESULTS: The cohort consisted of 1,989 patients: 98.5% male and a mean age of 74 yrs. For treatment, 44% of subjects received beta-lactam + fluoroquinolone and 56% received beta-lactam + macrolide. Unadjusted 30-day mortality was 27% for beta-lactam + fluoroquinolone and 24% for beta-lactam + macrolide (p = .11). In the multilevel models, the use of beta-lactam + fluoroquinolone was not significantly associated with 30-day mortality (odds ratio 1.05, 95% confidence interval 0.85-1.30). However, the use of beta-lactam + fluoroquinolone was significantly associated with increased mean length of stay (incidence rate ratio 1.30, 95% confidence interval 1.27-1.33). CONCLUSIONS: We found no significant difference for 30-day mortality but did demonstrate an association with increase in length of stay associated with the use of beta-lactam + fluoroquinolone. Randomized controlled trials are needed to determine the most effective antibiotics regimes for patients with severe pneumonia.
UR - http://www.scopus.com/inward/record.url?scp=84864278373&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84864278373&partnerID=8YFLogxK
U2 - 10.1097/CCM.0b013e31825151a8
DO - 10.1097/CCM.0b013e31825151a8
M3 - Article
C2 - 22622401
AN - SCOPUS:84864278373
VL - 40
SP - 2310
EP - 2314
JO - Critical Care Medicine
JF - Critical Care Medicine
SN - 0090-3493
IS - 8
ER -