科研之友
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摘要
Objective: Streptococcus pneumoniae (SP) represents a major pathogen in pneumonia. The impact of azithromycin on mortality in SP pneumonia remains unclear. Recent safety concerns regarding azithromycin have raised alarm about this agent%26apos;s role with pneumonia. We sought to clarify the relationship between survival and azithromycin use in SP pneumonia. %26lt;br%26gt;Design: Retrospective cohort. %26lt;br%26gt;Setting: Urban academic hospital. %26lt;br%26gt;Participants: Adults with a diagnosis of SP pneumonia (January-December 2010). The diagnosis of pneumonia required a compatible clinical syndrome and radiographic evidence of an infiltrate. %26lt;br%26gt;Intervention: None. %26lt;br%26gt;Primary and secondary outcome measures: Hospital mortality served as the primary endpoint, and we compared patients given azithromycin with those not treated with this. Covariates of interest included demographics, severity of illness, comorbidities and infection-related characteristics (eg, appropriateness of initial treatment, bacteraemia). We employed logistic regression to assess the independent impact of azithromycin on hospital mortality. %26lt;br%26gt;Results: The cohort included 187 patients (mean age: 67.0 +/- 8.2 years, 50.3% men, 5.9% admitted to the intensive care unit). The most frequently utilised non-macrolide antibiotics included: ceftriaxone (n=111), cefepime (n=31) and moxifloxacin (n=22). Approximately two-thirds of the cohort received azithromycin. Crude mortality was lower in persons given azithromycin (5.6% vs 23.6%, p%26lt;0.01). The final survival model included four variables: age, need for mechanical ventilation, initial appropriate therapy and azithromycin use. The adjusted OR for mortality associated with azithromycin equalled 0.26 (95% CI 0.08 to 0.80, p=0.018). %26lt;br%26gt;Conclusions: SP pneumonia generally remains associated with substantial mortality while azithromycin treatment is associated with significantly higher survival rates. The impact of azithromycin is independent of multiple potential confounders.
- 出版日期2013
