Empirical Atypical Coverage for Inpatients With Community-Acquired Pneumonia

Shefet, Daphna; Robenshtok, Eyal; Leibovici, Leonard

doi:10.1001/archinte.165.17.1992

Cited by 99 publications

(54 citation statements)

References 61 publications

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“…But, there are controversial results for atypical pathogen coverage treatment. A meta-analysis indicated that empirical antibiotic coverage of atypical pathogens in hospitalized patients with community-acquired pneumonia showed no benefit of survival or clinical efficacy in this synthesis of randomized trials (58). In contrast, a populationbased, multicenter, retrospective cohort study in China got opposite results (59).…”

Section: Antibiotic Treatment For Atypical Pneumoniamentioning

confidence: 83%

Atypical pathogen infection in community-acquired pneumonia

Fei

2016

BST

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Section: Antibiotic Treatment For Atypical Pneumoniamentioning

confidence: 83%

Atypical pathogen infection in community-acquired pneumonia

Fei

2016

BST

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“…and C. pneumoniae were both found in three patients, which might explain why regimens covering these organisms did not substantially affect the outcome in the current study. Moreover, evidence is lacking that clinical outcomes are improved by using antibiotics that are active against atypical pathogens, at least in nonsevere CAP [31,32].…”

Section: Discussionmentioning

confidence: 99%

Impact of initial antibiotic choice on mortality from pneumococcal pneumonia

Aspa¹,

Rajas²,

Castro³

et al. 2006

Eur Respir J

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To determine the impact of initial antimicrobial choice on 30-day mortality rate in patients with community-acquired pneumonia due to Streptococcus pneumoniae (CAP-SP), a prospective, observational study was conducted in 35 Spanish hospitals. A total of 638 patients with CAP-SP were identified. Antimicrobials were chosen by the attending physician. Patients were grouped into the following categories: b-lactam monotherapy (n5251), macrolide monotherapy (n537), b-lactam plus macrolide (n5198), levofloxacin alone/combination (n548), and other combinations (n5104). The reference category was b-lactam+macrolide.The 30-day survival probability was 84.9%. Using multivariate survival analysis, factors related to mortality in the entire population were: bilateral disease, suspected aspiration, shock, HIV infection, renal failure and pneumonia severity index (PSI) score Class IV versus I-III and categories V versus I-III. The association of b-lactams+macrolides was not better than the use of b-lactams alone. The current authors analysed the different groups of patients with significant mortality/morbidity: intensive care unit, PSI Class .III, renal failure, chronic lung disease and bacteraemia. Only in patients with PSI Class .III, who had undergone initial antimicrobial choice classified as other combinations, were associated with higher mortality.In conclusion, the current authors have not demonstrated an independent association between initial antimicrobial regimen and 30-day mortality in community-acquired pneumococcal pneumonia patients, except for those with a higher pneumonia severity index score.

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“…This recommendation requires close monitoring, since outbreaks of atypical pathogen pneumonia can occur among nursing home residents, mainly Legionella spp. Conflicting data from two recent meta-analyses in patients with mild and moderate CAP showed that atypical coverage did not have an impact on patient's outcomes [30,31]. However, from the subgroup analysis, patients with Legionella infections tended to do worse if atypical coverage was not added [30,31].…”

Section: Discussionmentioning

confidence: 88%