Metersky Mark L, Ma Allen, Houck Peter M, Bratzler Dale W
Division of Pulmonary and Critical Care Medicine, University of Connecticut Health Center, 263 Farmington Ave, Farmington, CT 06030-1321, USA.
Chest. 2007 Feb;131(2):466-73. doi: 10.1378/chest.06-1426.
The questions of whether the use of antibiotics that are active against atypical organisms is beneficial in the treatment of community-acquired pneumonia and of the potential mechanisms of any beneficial effects remain unresolved. Proposed mechanisms include activity against atypical organisms vs the immunomodulatory effects of these antibiotics. The study of outcomes of a large cohort of patients with bacteremic pneumonia provides a unique opportunity to address these questions by excluding patients with primary atypical infection.
We reviewed data from the charts of 2,209 Medicare patients who were admitted to hospitals across the United States from either home or a nursing facility with bacteremic pneumonia between 1998 and 2001. Patients were stratified according to the type of antibiotic treatment. Multivariate modeling was performed to assess the relationship between the class of antibiotic used and several outcome variables.
The initial use of any antibiotic active against atypical organisms was independently associated with a decreased risk of 30-day mortality (odds ratio [OR], 0.76; 95% confidence interval [CI], 0.59 to 0.98; p = 0.03) and hospital admission within 30 days of discharge (OR, 0.67; 95% CI, 0.51 to 0.89; p = 0.02). Further analysis revealed that the benefits of atypical treatment were associated with the use of macrolides, but not the use of fluoroquinolones or tetracyclines, with macrolides conferring lower risks of in-hospital mortality (OR, 0.59; 95% CI, 0.40 to 0.88; p = 0.01), 30-day mortality (OR, 0.61; 95% CI, 0.43 to 0.87; p = 0.007), and hospital readmission within 30 days of discharge (OR, 0.59; 95% CI, 0.42 to 0.85; p = 0.004).
Initial antibiotic treatment including a macrolide agent is associated with improved outcomes in Medicare patients hospitalized with bacteremic pneumonia. These results have implications regarding the mechanism by which the use of a macrolide for treatment of pneumonia is associated with improved outcomes.
对非典型病原体有效的抗生素用于社区获得性肺炎治疗是否有益以及任何有益效果的潜在机制问题仍未解决。提出的机制包括对非典型病原体的活性与这些抗生素的免疫调节作用。对大量菌血症性肺炎患者的结局进行研究，通过排除原发性非典型感染患者，为解决这些问题提供了独特的机会。
我们回顾了1998年至2001年间从家中或护理机构因菌血症性肺炎入住美国各地医院的2209名医疗保险患者的病历数据。根据抗生素治疗类型对患者进行分层。进行多变量建模以评估所用抗生素类别与几个结局变量之间的关系。
最初使用任何对非典型病原体有效的抗生素与30天死亡率降低（比值比[OR]，0.76；95%置信区间[CI]，0.59至0.98；p = 0.03）以及出院后30天内再次住院（OR，0.67；95%CI，0.51至0.89；p = 0.02）独立相关。进一步分析显示，非典型治疗的益处与大环内酯类药物的使用有关，而与氟喹诺酮类或四环素类药物的使用无关，大环内酯类药物使住院死亡率（OR，0.59；95%CI，0.40至0.88；p = 0.01）、30天死亡率（OR，0.61；95%CI，0.43至0.87；p = 0.007）和出院后30天内再次住院（OR，0.59；95%CI，0.42至0.85；p = 0.004）的风险降低。
包括大环内酯类药物的初始抗生素治疗与菌血症性肺炎住院的医疗保险患者结局改善有关。这些结果对大环内酯类药物用于肺炎治疗与结局改善相关的机制具有启示意义。
