Atypical coverage in community-acquired pneumonia after outpatient beta-lactam monotherapy

作者：van Werkhoven Cornelis H^*; van de Garde Ewoudt M W; Oosterheert Jan Jelrik; Postma Douwe F; Bonten Marc J M

来源：Respiratory Medicine, 2017, 129: 145-151.

DOI：10.1016/j.rmed.2017.06.012

• Community-acquired pneumonia
• Antibiotics
• Empirical treatment
• Atypical pathogens
• Treatment escalation

Introduction: In adults hospitalized with community-acquired pneumonia (CAP) after >48 h of outpatient beta-lactam monotherapy, coverage of atypical pathogens is recommended based on expert opinion.
Methods: In a post-hoc analysis of a large study of CAP treatment we included patients who received beta-lactam monotherapy for >48 h before hospitalization. Length of hospital stay (LOS), 30-day mortality, and number of treatment escalations were compared for those that continued beta-lactam monotherapy and those that received atypical coverage at admission.
Results: Of 179 patients (median age 66 years (IQR 50-78), 100 (56%) male), 131 (73%) received additional atypical coverage at admission. These patients were younger, had less comorbidities, and longer symptom duration, compared to those that continued beta-lactam monotherapy. In crude analysis, median (IQR) LOS was 6 (4-8) and 6 (4-9) days, mortality was 2% and 4%, and treatment escalations occurred in 8 (17%) and 11 (8%) patients without and with atypical coverage, respectively. Adjusted effect ratios for absence of atypical coverage on LOS, mortality, and treatment escalation were 0.77 (95% CI 0.61 -0.97), 0.37 (0.04-3.67), and 2.75 (0.94-8.09), respectively.
Conclusion: In adults hospitalized with CAP after >48 h of outpatient beta-lactam monotherapy, not starting antibiotics with atypical coverage was associated with a trend towards more treatment escalations, without evidence of increased LOS or mortality.

• 出版日期2017-8