Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan.
Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan; Department of Respiratory Medicine, National Hospital Organization Minami Kyoto Hospital, 11 Nakaashihara, Joyo, Kyoto 610-0113, Japan.
J Infect Chemother. 2021 Oct;27(10):1447-1453. doi: 10.1016/j.jiac.2021.06.003. Epub 2021 Jun 17.
Whether β-lactam and macrolide combination therapy reduces mortality in severe community-acquired pneumonia (SCAP) patients hospitalized in the intensive care unit (ICU) is controversial. The aim of the present study was to evaluate the usefulness of β-lactam and macrolide combination therapy for SCAP patients hospitalized in the ICU.
A prospective, observational, cohort study of hospitalized pneumonia patients was performed. Hospitalized SCAP patients admitted to the ICU within 24 h between October 2010 and October 2017 were included for analysis. The primary outcome was 30-day mortality, and secondary outcomes were 14-day mortality and ICU mortality. Inverse probability of treatment weighting (IPTW) analysis as a propensity score analysis was used to reduce biases, including six covariates: age, sex, C-reactive protein, albumin, Pneumonia Severity Index score, and APACHE II score.
A total of 78 patients were included, with 48 patients in the non-macrolide-containing β-lactam therapy group and 30 patients in the macrolide combination therapy group. β-lactam and macrolide combination therapy significantly decreased 30-day mortality (16.7% vs. 43.8%; P = 0.015) and 14-day mortality (6.7% vs. 31.3%; P = 0.020), but not ICU mortality (10% vs 27.1%, P = 0.08) compared with non-macrolide-containing β-lactam therapy. After adjusting by IPTW, macrolide combination therapy also decreased 30-day mortality (odds ratio, 0.29; 95%CI, 0.09-0.96; P = 0.04) and 14-day mortality (odds ratio, 0.19; 95%CI, 0.04-0.92; P = 0.04), but not ICU mortality (odds ratio, 0.34; 95%CI, 0.08-1.36; P = 0.13).
Combination therapy with β-lactam and macrolides significantly improved the prognosis of SCAP patients hospitalized in the ICU compared with a non-macrolide-containing β-lactam regimen.
在重症监护病房（ICU）住院的严重社区获得性肺炎（SCAP）患者中，β-内酰胺和大环内酯类联合治疗是否降低死亡率存在争议。本研究旨在评估β-内酰胺和大环内酯类联合治疗对 ICU 住院 SCAP 患者的疗效。
进行了一项前瞻性、观察性、队列研究，纳入了 2010 年 10 月至 2017 年 10 月期间入住 ICU 的住院肺炎患者。对入住 ICU 24 小时内确诊为 SCAP 的患者进行分析。主要结局为 30 天死亡率，次要结局为 14 天死亡率和 ICU 死亡率。采用逆概率治疗加权（IPTW）分析作为倾向评分分析，以减少包括年龄、性别、C 反应蛋白、白蛋白、肺炎严重指数评分和急性生理学与慢性健康状况评分 II （APACHE II）评分在内的 6 个协变量的偏倚。
共纳入 78 例患者，其中非大环内酯类β-内酰胺治疗组 48 例，大环内酯类联合治疗组 30 例。与非大环内酯类β-内酰胺治疗组相比，β-内酰胺和大环内酯类联合治疗组显著降低了 30 天死亡率（16.7% vs. 43.8%；P=0.015）和 14 天死亡率（6.7% vs. 31.3%；P=0.020），但对 ICU 死亡率（10% vs. 27.1%；P=0.08）无显著影响。经 IPTW 校正后，联合治疗组 30 天死亡率（比值比，0.29；95%置信区间，0.09-0.96；P=0.04）和 14 天死亡率（比值比，0.19；95%置信区间，0.04-0.92；P=0.04）也显著降低，但 ICU 死亡率（比值比，0.34；95%置信区间，0.08-1.36；P=0.13）无显著变化。
与非大环内酯类β-内酰胺方案相比，β-内酰胺和大环内酯类联合治疗可显著改善 ICU 住院 SCAP 患者的预后。
