Para acceder a los documentos con el texto completo, por favor, siga el siguiente enlace: http://hdl.handle.net/2445/136294
dc.contributor.author | Ceccato, Adrian |
---|---|
dc.contributor.author | Cillóniz, Catia |
dc.contributor.author | Martín Loeches, Ignacio |
dc.contributor.author | Ranzani, Otavio T. |
dc.contributor.author | Gabarrús, Albert |
dc.contributor.author | Bueno, Leticia |
dc.contributor.author | Garcia Vidal, Carolina |
dc.contributor.author | Ferrer Monreal, Miquel |
dc.contributor.author | Niederman, Michael S. |
dc.contributor.author | Torres Martí, Antoni |
dc.date | 2019-07-03T12:31:46Z |
dc.date | 2019-04-01 |
dc.date | 2019-07-03T12:31:46Z |
dc.identifier | 0012-3692 |
dc.identifier | 686167 |
dc.identifier | 30471269 |
dc.identifier.uri | http://hdl.handle.net/2445/136294 |
dc.description | Antibiotic combinations that include macrolides have shown lower mortality rates than β-lactams in monotherapy or combined with fluoroquinolones in patients with community-acquired pneumonia (CAP). However, this effect has not been studied according to the levels of C-reactive protein in CAP with identified microbial cause. In patients with CAP and known microbial cause we aimed to evaluate 30-day mortality of a β-lactam plus macrolide (BL + M) compared with a fluoroquinolone alone or with a β-lactam (FQ ± BL). METHODS: We analyzed a prospective observational cohort of patients with CAP admitted to the Hospital Clinic of Barcelona between 1996 and 2016. We included only patients with known microbial cause. RESULTS: Of 1,715 patients (29%) with known etiology, a total of 932 patients (54%) received BL + M. Despite lower crude mortality in the BL + M group in the overall population (BL + M, 5% vs FQ ± BL, 8%; P = .015), after adjustment by a propensity score and baseline characteristics, the combination of BL + M had a protective effect on mortality only in patients with high inflammatory response (C-reactive protein, > 15 mg/dL) and pneumococcal CAP (adjusted OR, 0.28; 95% CI, 0.09-0.93). No benefits on mortality were observed for the population without high inflammatory response and pneumococcal CAP or with other etiologies. CONCLUSIONS: The combination of a β-lactam with a macrolide was associated with decreased mortality in patients with pneumococcal CAP and in patients with high systemic inflammatory response. When both factors occurred together, BL + M was protective for mortality in the multivariate analysis. |
dc.format | 10 p. |
dc.format | application/pdf |
dc.language | eng |
dc.publisher | American College of Chest Physicians |
dc.relation | Versió postprint del document publicat a: https://doi.org/10.1016/j.chest.2018.11.006 |
dc.relation | Chest, 2018, vol. 155, num. 4, p. 795-804 |
dc.relation | https://doi.org/10.1016/j.chest.2018.11.006 |
dc.rights | (c) American College of Chest Physicians, 2018 |
dc.rights | info:eu-repo/semantics/openAccess |
dc.subject | Pneumònia adquirida a la comunitat |
dc.subject | Inflamació |
dc.subject | Pneumococs |
dc.subject | Community-acquired pneumonia |
dc.subject | Inflammation |
dc.subject | Streptococcus pneumonia |
dc.title | Effect of combined β-Lactam/Macrolide therapy on mortality according to the microbial etiology and inflammatory status of patients with community-acquired pneumonia |
dc.type | info:eu-repo/semantics/article |
dc.type | info:eu-repo/semantics/acceptedVersion |