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Title: Effectiveness of combination therapy versus monotherapy with a third-generation cephalosporin in bacteraemic pneumococcal pneumonia: A propensity score analysis
Author: Calle, C. De la
Ternavasio de la Vega, H. G.
Morata, Laura
Marco Reverté, Francesc
Cardozo Espinola, Celia
Garcia Vidal, Carolina
Rio, Ana del
Cillóniz, Catia
Torres Martí, Antoni
Martínez, José Antonio
Mensa Pueyo, Josep
Soriano Viladomiu, Alex
Keywords: Pneumònia
Streptococcus pneumonia
Issue Date: Apr-2018
Publisher: Elsevier
Abstract: Objective: Combining a macrolide or a fluoroquinolone to beta-lactam regimens in the treatment of patients with moderate to severe community-acquired pneumonia is recommended by the international guidelines. However, the information in patients with bacteraemic pneumococcal pneumonia is limited. Methods: A propensity score technique was used to analyze prospectively collected data from all patients with bacteraemic pneumococcal pneumonia admitted from 2000 to 2015 in our institution, who had received empirical treatment with third-generation cephalosporin in monotherapy or plus macrolide or fluoroquinolone. Results: We included 69 patients in the monotherapy group and 314 in the combination group. After adjustment by PS for receiving monotherapy, 30-day mortality (OR 2.89; 95% CI 1.07-7.84) was significantly higher in monotherapy group. A higher 30-day mortality was observed in monotherapy group in both 1:1 and 1:2 matched samples although it was statistically significant only in 1:2 sample (OR: 3.50 (95% CI 1.03-11.96), P = 0.046). Conclusions: Our study suggests that in bacteraemic pneumococcal pneumonia, empirical therapy with a third-generation cephalosporin plus a macrolide or a fluoroquinolone is associated with a lower mortality rate than beta-lactams in monotherapy. These results support the recommendation of combination therapy in patients requiring admission with moderate to severe disease.
Note: Versió postprint del document publicat a:
It is part of: Journal of Infection, 2018, vol. 76, num. 4, p. 342-347
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ISSN: 0163-4453
Appears in Collections:Articles publicats en revistes (Medicina)
Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer)

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