Journal Article

Addition of a Macrolide to a β-Lactam-Based Empirical Antibiotic Regimen Is Associated with Lower In-Hospital Mortality for Patients with Bacteremic Pneumococcal Pneumonia

José A. Martínez, Juan P. Horcajada, Manuel Almela, Francesc Marco, Alex Soriano, Elisa Garcí a, Maria Angeles Marco, Antoni Torres and Josep Mensa

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 36, issue 4, pages 389-395
Published in print February 2003 | ISSN: 1058-4838
Published online February 2003 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/367541
Addition of a Macrolide to a β-Lactam-Based Empirical Antibiotic Regimen Is Associated with Lower In-Hospital Mortality for Patients with Bacteremic Pneumococcal Pneumonia

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To assess the association between inclusion of a macrolide in a β-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 β-lactam plus a macrolide and 171 (42%) received a β-lactam without a macrolide. Multivariate analysis revealed 4 variables to be independently associated with death: shock (P <.0001), age of ≥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 β-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.

Journal Article.  3486 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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