Clinical Characteristics at Initial Presentation and Impact of Dual Therapy on the Outcome of Bacteremic Streptococcus pneumoniae Pneumonia in Adults

Abstract

BACKGROUND:Approximately 10% of patients hospitalized with community-acquired pneumonia (CAP) are bacteremic. BacteremicStreptococcus pneumoniaepneumonia (BSPP) is the number one cause of mortality, representing up to 70% of all CAP deaths. In fact, all CAP guidelines have identified this issue as one of the most important issues when establishing their recommendations.OBJECTIVE:To assess the impact of dual antibiotic therapy in patients with BSPP.PATIENTS AND METHODS:All cases of BSPP in patients 18 years of age and older who were hospitalized from 1995 to 2000 were retrospectively analyzed. The standard initial therapeutic regimen used was cefuroxime with or without a macrolide from 1995 to 1997, and ceftriaxone and azithromycin or clarithromycin from 1998 to 2000. During the 1995 to 1997 period, only 16% of the patients initially received a macrolide, whereas all patients in the 1998 to 2000 period received a macrolide at admission.RESULTS:Ninety-five patients (49 men, 46 women) with a mean age of 63 years (range 20 to 98 years) were included in the present study. The mean pneumonia severity index at admission was 113 for the monotherapy cohort and 114 for the dual therapy group. At admission, 30.5% of patients had a leukocyte count greater than 20´109/L, 11.5% had a systolic blood pressure less than 90 mmHg, 44.2% had a respiratory rate greater than 30 breaths/min and 33.6% had nausea/vomiting, necessitating some form of therapy or preventing the patient from eating. In addition, 16.8% had no fever at admission. Overall, 72.5% became afebrile within 48 h. Fifteen (15.8%) patients died (four within the first 72 h). The mortality rate was significantly higher in the monotherapy group (11 of 42 patients; 25.6%) than in the dual therapy cohort (four of 53 patients; 7.5%) (OR 0.23; 95% CI 0.07 to 0.74). Antibiotic resistance was not associated with increased mortality.CONCLUSION:The combination of ceftriaxone plus a macrolide significantly reduced the mortality rate compared with monotherapy (cefuroxime) in patients with CAP that have the highest mortality rate.

Implications of COPD in patients admitted to the intensive care unit by community-acquired pneumonia

“…WATERER et al [23] suggested that monotherapy may be suboptimal for patients with bacteraemic S. pneumoniae pneumonia, whatever treatment is given. Further studies [24][25][26][27] agree with these findings, but the controversy should be resolved by conducting a randomised clinical trial.…”

Burden of Antibiotic Resistance in Common Infectious Diseases: Role of Antibiotic Combination Therapy

“…In addition, rational antibiotic combination therapies associated with reduced mortality and were reported to produce better clinical outcome in patient who are at risk for treatment failure [8].…”

Treatment with anti‐inflammatory drugs in community‐acquired pneumonia

“…In several retrospective or nonrandomized prospective clinical studies, a survival benefit has been shown in patients with pneumococcal CAP treated with a combination of b-lactam antibiotics and macrolides compared with those treated with b-lactam monotherapy [61][62][63][64][65]. However, two large prospective cohort studies showed no difference between these two regimens [66,67].…”