大环内酯类药物对菌血症性肺炎链球菌肺炎死亡率的影响：一项回顾性、全国性队列研究，以色列，2009-2017 年。

The Effect of Macrolides on Mortality in Bacteremic Pneumococcal Pneumonia: A Retrospective, Nationwide Cohort Study, Israel, 2009-2017.

机构信息

Infectious Diseases Unit, Meir Medical Center, kfar-Saba, Israel.

Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.

出版信息

Clin Infect Dis. 2022 Dec 19;75(12):2219-2224. doi: 10.1093/cid/ciac317.

DOI:10.1093/cid/ciac317

PMID:35443039

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9761884/

Abstract

BACKGROUND

Previous cohort studies of pneumonia patients reported lower mortality with advanced macrolides. Our aim was to characterize antibiotic treatment patterns and assess the role of quinolones or macrolides in empirical therapy.

MATERIALS

An historical cohort, 1 July 2009 to 30 June 2017, included, through active surveillance, all culture-confirmed bacteremic pneumococcal pneumonia (BPP) among adults in Israel. Cases without information on antibiotic treatment were excluded. Logistic regression analysis was used to assess independent predictors of in-hospital mortality.

RESULTS

A total of 2016 patients with BPP were identified. The median age was 67.2 years (interquartile range [IQR] 53.2-80.6); 55.1% were men. Lobar pneumonia was present in 1440 (71.4%), multi-lobar in 576 (28.6%). Median length of stay was 6 days (IQR 4-11). A total of 1921 cases (95.3%) received empiric antibiotics with anti-pneumococcal coverage: ceftriaxone, in 1267 (62.8%). Coverage for atypical bacteria was given to 1159 (57.5%), 64% of these, with macrolides. A total of 372 (18.5%) required mechanical ventilation, and 397 (19.7%) died. Independent predictors of mortality were age (odds ratio [OR] 1.051, 95% confidence interval [CI] 1.039, 1.063), being at high-risk for pneumococcal disease (OR 2.040, 95% CI 1.351, 3.083), multi-lobar pneumonia (OR 2.356, 95% CI 1.741, 3.189). Female sex and macrolide therapy were predictors of survival: (OR 0.702, 95% CI .516, .955; and OR 0.554, 95% CI .394, .779, respectively). Either azithromycin or roxithromycin treatment for as short as two days was predictor of survival. Quinolone therapy had no effect.

CONCLUSIONS

Empirical therapy with macrolides reduced odds for mortality by 45%. This effect was evident with azithromycin and with roxithromycin. The effect did not require a full course of therapy.

摘要

背景

既往肺炎患者队列研究显示，使用高级大环内酯类药物可降低死亡率。我们旨在描述抗生素治疗模式，并评估喹诺酮类或大环内酯类药物在经验性治疗中的作用。

材料

本研究为 2009 年 7 月 1 日至 2017 年 6 月 30 日期间通过主动监测的方法，纳入所有以色列成人确诊菌血症性肺炎（BPP）患者的回顾性队列研究。排除了未提供抗生素治疗信息的病例。采用逻辑回归分析评估院内死亡率的独立预测因素。

结果

共纳入 2016 例 BPP 患者，中位年龄为 67.2 岁（四分位间距 [IQR] 53.2-80.6）；55.1%为男性。1440 例（71.4%）存在肺叶性肺炎，576 例（28.6%）存在多叶性肺炎。中位住院时间为 6 天（IQR 4-11）。1921 例（95.3%）患者接受了具有抗肺炎球菌覆盖的经验性抗生素治疗：头孢曲松 1267 例（62.8%）。576 例（28.6%）给予了覆盖非典型病原体的抗生素治疗，其中 64%联合使用了大环内酯类药物。372 例（18.5%）需要机械通气，397 例（19.7%）死亡。死亡率的独立预测因素包括年龄（比值比 [OR] 1.051，95%置信区间 [CI] 1.039，1.063）、发生肺炎球菌病的高危风险（OR 2.040，95%CI 1.351，3.083）、多叶性肺炎（OR 2.356，95%CI 1.741，3.189）。女性和大环内酯类药物治疗是生存的预测因素：（OR 0.702，95%CI 0.516，0.955；和 OR 0.554，95%CI 0.394，0.779，分别）。阿奇霉素或罗红霉素治疗 2 天即可降低死亡率的可能性（OR 0.554，95%CI 0.394，0.779）。喹诺酮类药物治疗无影响。