Narrow-spectrum beta-lactam monotherapy in hospital treatment of community-acquired pneumonia: a register-based cohort study

作者：Rhedin S; Galanis I; Granath F; Ternhag A; Hedlund J; Spindler C; Naucler P

来源：Clinical Microbiology and Infection, 2017, 23(4): 247-252.

DOI：10.1016/j.cmi.2016.12.015

• Adults
• beta-Lactam antibiotics
• Cohort studies
• Mortality
• Pneumonia

Objectives: To assess the clinical effect of empirical treatment with narrow-spectrum beta-lactam monotherapy (NSBM) versus broad-spectrum beta-lactam monotherapy (BSBM) in non-severe community-acquired pneumonia (CAP).
Methods: Hospitalized patients >= 18 years with CAP who received initial NSBM or BSBM, with a severity score according to CRB-65 <= 2 (C = confusion, R = respira tory rate >30/min, B=systolic blood pressure <90 mmHg or diastolic blood pressure <= 60 mmHg, 65= >= 65 years), in the Swedish Pneumonia Register from 2008 to 2011 were included. Primary outcome was 30-day mortality. Secondary outcomes were 90-day mortality, treatment at intensive care unit (ICU), and length of stay (LOS). Propensity score matching was performed to account for differences in baseline characteristics.
Results: There were 5961 patients with CRB-65 <= 1 and 1344 patients with CRB-65=2. In the propensity score matched cohorts the 30-day mortality was 40/1827 (2.2%) with NSBM and 56/1827 (3.1%) with BSBM in CRB-65 <= 1, and 57/524 (10.9%) and 51/524 (9.7%), respectively, in CRB-65=2. No significant differences in 30-day mortality were observed between NSBM and BSBM in patients with CRB-65 <= 1 or CRB-65=2, OR 1.41 (95% CI 0.94-2.14) and 0.88 (95% CI 0.59-1.32), respectively. There was no significant difference in 90-day mortality. Patients who received BSBM were more often treated at ICU and had longer LOS.
Conclusions: Empirical NSBM appears to be effective in the majority of hospitalized immunocompetent adults with non-severe CAP and should be further evaluated in randomized trials. S.

• 出版日期2017-4