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http://hdl.handle.net/2445/136294
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DC Field | Value | Language |
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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.accessioned | 2019-07-03T12:31:46Z | - |
dc.date.issued | 2019-04-01 | - |
dc.identifier.issn | 0012-3692 | - |
dc.identifier.uri | http://hdl.handle.net/2445/136294 | - |
dc.description.abstract | 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.extent | 10 p. | - |
dc.format.mimetype | application/pdf | - |
dc.language.iso | eng | - |
dc.publisher | American College of Chest Physicians | - |
dc.relation.isformatof | Versió postprint del document publicat a: https://doi.org/10.1016/j.chest.2018.11.006 | - |
dc.relation.ispartof | Chest, 2018, vol. 155, num. 4, p. 795-804 | - |
dc.relation.uri | https://doi.org/10.1016/j.chest.2018.11.006 | - |
dc.rights | (c) American College of Chest Physicians, 2018 | - |
dc.source | Articles publicats en revistes (Medicina) | - |
dc.subject.classification | Pneumònia adquirida a la comunitat | - |
dc.subject.classification | Inflamació | - |
dc.subject.classification | Pneumococs | - |
dc.subject.other | Community-acquired pneumonia | - |
dc.subject.other | Inflammation | - |
dc.subject.other | 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 | - |
dc.identifier.idgrec | 686167 | - |
dc.date.updated | 2019-07-03T12:31:46Z | - |
dc.rights.accessRights | info:eu-repo/semantics/openAccess | - |
dc.identifier.pmid | 30471269 | - |
Appears in Collections: | Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer) Articles publicats en revistes (Medicina) |
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File | Description | Size | Format | |
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686167.pdf | 442.13 kB | Adobe PDF | View/Open |
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