Narrow-spectrum ß-lactam monotherapy in hospital treatment of community-acquired pneumonia: a register-based cohort study.
Τίτλος | Narrow-spectrum ß-lactam monotherapy in hospital treatment of community-acquired pneumonia: a register-based cohort study. |
Publication Type | Journal Article |
Year of Publication | 2017 |
Authors | Rhedin, S., Galanis I., Granath F., Ternhag A., Hedlund J., Spindler C., & Naucler P. |
Journal | Clin Microbiol Infect |
Volume | 23 |
Issue | 4 |
Pagination | 247-252 |
Date Published | 2017 Apr |
ISSN | 1469-0691 |
Λέξεις κλειδιά | Adult, Aged, Aged, 80 and over, Anti-Bacterial Agents, beta-Lactams, Cohort Studies, Community-Acquired Infections, Comorbidity, Female, Hospitalization, Humans, Intensive Care Units, Length of Stay, Male, Middle Aged, Odds Ratio, Pneumonia, Bacterial, Treatment Outcome |
Abstract | OBJECTIVES: To assess the clinical effect of empirical treatment with narrow-spectrum ß-lactam monotherapy (NSBM) versus broad-spectrum ß-lactam monotherapy (BSBM) in non-severe community-acquired pneumonia (CAP).METHODS: Hospitalized patients ≥18 years with CAP who received initial NSBM or BSBM, with a severity score according to CRB-65≤2 (C=confusion, R=respiratory rate >30/min, B=systolic blood pressure <90 mmHg or diastolic blood pressure ≤60 mmHg, 65= ≥65 years), in the Swedish Pneumonia Register from 2008 to 2011 were included. Primary outcome was 30-day mortality. Secondary outcomes were 90-day mortality, treatment at intensive care unit (ICU), and length of stay (LOS). Propensity score matching was performed to account for differences in baseline characteristics.RESULTS: There were 5961 patients with CRB-65≤1 and 1344 patients with CRB-65=2. In the propensity score matched cohorts the 30-day mortality was 40/1827 (2.2%) with NSBM and 56/1827 (3.1%) with BSBM in CRB-65≤1, and 57/524 (10.9%) and 51/524 (9.7%), respectively, in CRB-65=2. No significant differences in 30-day mortality were observed between NSBM and BSBM in patients with CRB-65≤1 or CRB-65=2, OR 1.41 (95% CI 0.94-2.14) and 0.88 (95% CI 0.59-1.32), respectively. There was no significant difference in 90-day mortality. Patients who received BSBM were more often treated at ICU and had longer LOS.CONCLUSIONS: Empirical NSBM appears to be effective in the majority of hospitalized immunocompetent adults with non-severe CAP and should be further evaluated in randomized trials. |
DOI | 10.1016/j.cmi.2016.12.015 |
Alternate Journal | Clin. Microbiol. Infect. |
PubMed ID | 28017793 |