Impact of initial antibiotic choice on mortality from pneumococcal pneumonia

Aspa, Javier; Rajas, Olga; Castro, Felipe Rodrı́guez de; Huertas, MC; Borderías, Luis; Cabello, F.J.; Tàbara, J. David; Hernández-Flix, Salvador; Martínez-Sanchís, A; Torres, Antoni

doi:10.1183/09031936.06.00126004

Cited by 79 publications

(40 citation statements)

References 43 publications

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“…Taking into account the relationship between IL-6 and poor prognosis for PP, the modulation of the expression of this cytokine may be a key point for improving patient outcomes. Whether combination therapy can improve outcomes in patients with CAP is a controversial issue [21][22][23][24][25][26]. Moreover, most studies have used the combination of -lactam plus macrolide, not -lactam plus fluoroquinolone.…”

Section: Discussionmentioning

confidence: 99%

Impact of antibiotic therapy on systemic cytokine expression in pneumococcal pneumonia

Padrones

García-Vidal

Fernández-Serrano

et al. 2010

Eur J Clin Microbiol Infect Dis

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Purpose: The aim of this study was to compare the evolution of systemic cytokine levels over time in patients with pneumococcal pneumonia treated either with ß-lactam monotherapy or with combination therapy (ß-lactam plus fluoroquinolone). Methods: Prospective observational study of hospitalized non-immunocompromised adults with PP. Concentrations of IL-6, IL-8, IL-10 and TNF-α were determined on days 0, 1, 2, 3, 5, and 7. Patients on ß-lactam monotherapy were compared with those receiving combination therapy. Results: Fifty-two patients were enrolled in the study. Concentrations of IL-6, IL-8, and IL-10 decreased rapidly in the first days after admission, in accordance with the mean time to defervescence. High levels of IL-6 were found in patients with the worst outcomes, measured by the need for intensive care unit admission and mortality. No major differences in demographic or clinical characteristics or severity of disease were found between patients treated with ß-lactam monotherapy or combination therapy. IL-6 levels fell more rapidly in patients with combination therapy in the first 48 hours (p=0.016). Conclusions: Our data suggest that systemic expression of IL-6 production in patients with PP is correlated with prognosis. Initial combination antibiotic therapy produces a faster decrease in this cytokine in the first 48 hours. We submitted you the revised manuscript entitled "Impact of antibiotic therapy on systemic cytokine expression in pneumococcal pneumonia". We have taken into consideration all the reviewer's suggestions. Please find below a list of responses point by point to the reviewers' comments. Sincerely, Carolina Garcia-Vidal Infectious Diseases Service. Hospital Universitari de Bellvitge Feixa llarga s/n. 08907 L'Hospitalet, Barcelona, Spain E-mail: caroglv75@hotmail.com Fax: 34 93 2607637Comments to the Author:Reviewer #1: Prospective, non randomized study on the evolution and the impact of antibiotic therapy on systemic cytokine expression in pneumococcal pneumonia. A total of 52 patients enrolled. Data on the evolution of the systemic cytokine levels obtained every 24 hours during the first 5 days and on day 7. In 39 selected patients, the impact of B-lactam alone vs. Blactam plus fluoroquinolone on the systemic cytokine levels was assessed. Results showed that high levels of IL-6 at inclusion predicted the worst outcomes, including admission to ICU and mortality. In the group of patients treated with the combination, IL-6 levels fell more rapidly in the first 48 hours. COMMENTSThe study confirms previous reports that have shown a correlation of IL-6 levels at entry and prognosis. The results of the comparative study on the impact of antibiotic therapy showed that combination therapy was associated with a faster decrease in IL-6 in the first 24 and 48 hours of treatment. The Introduction, Methods and Results are appropriate and pertinent information is provided. In the Discussion, the authors elaborate considerably on the potential advantages of combination vs. monotherapy in C...

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Section: Discussionmentioning

confidence: 99%

Impact of antibiotic therapy on systemic cytokine expression in pneumococcal pneumonia

Padrones

García-Vidal

Fernández-Serrano

et al. 2010

Eur J Clin Microbiol Infect Dis

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“…Few studies showed no effect [25][26][27][28]. Some features of these studies are described in table 4; most studies were retrospective.…”

Section: Discussionmentioning

confidence: 99%

The need for macrolides in hospitalised community-acquired pneumonia: propensity analysis

Paul

Nielsen²,

Gafter‐Gvili³

et al. 2007

Eur Respir J

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on behalf of the TREAT Study Group ABSTRACT: The present study compared b-lactam macrolide (''combination'') therapy versus b-lactam alone (''monotherapy'') for hospitalised community-acquired pneumonia, using propensity scores to adjust for the differences between patients.A prospective multinational observational study was carried out. Baseline patient and infection characteristics were used to develop a propensity score for combination therapy. Patients were matched by the propensity score (three decimal point precision) and compared with 30-day mortality and hospital stay. The propensity score was used as a covariate in a logistic model for mortality.Patients treated with monotherapy (n5169) were older (mean¡SD age 70.6¡17.3 versus 65.0¡19.6 yrs), had a higher chronic diseases score and a different clinical presentation compared with patients treated with combination therapy (n5282). Unadjusted mortality was significantly higher with monotherapy (37 (22%) out of 169 versus 21 (7%) out of 282). Only 27 patients in the monotherapy group could be matched to 27 patients in the combination group using the propensity score. The mortality in these groups was identical, with three (11%) demises each. The multivariable odds ratio for mortality associated with combination therapy, adjusted for the propensity score and the Pneumonia Severity Index, was 0.69 (95% confidence interval 0.32-1.48).The benefit of combination therapy versus monotherapy cannot be reliably assessed in observational studies, since the propensity to prescribe these regimens differs markedly.

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“…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]. In a retrospective study in patients with severe sepsis owing to pneumonia caused by any microorganism, macrolide use was associated with decreased mortality, even in patients with macrolideresistant pathogens [68].…”

Section: Macrolide Antibioticsmentioning

confidence: 99%