Medline ® Abstracts for References 45,46
of 'Treatment of community-acquired pneumonia in adults who require hospitalization'
What is the best antimicrobial treatment for severe community-acquired pneumonia (including the role of steroids and statins and other immunomodulatory agents).
Sibila O, Restrepo MI, Anzueto A
Infect Dis Clin North Am. 2013 Mar;27(1):133-47. Epub 2012 Dec 21.
Community-acquired pneumonia (CAP) is the leading cause of death from infectious diseases in the United States. The mortality rate due to severe CAP has shown little improvement over the past few years, with a rate as high as 50% mainly in patients admitted to intensive care units. Death and adverse outcomes from CAP result from a complex interplay between the pathogen and the host. Several therapies have been tested in patients with severe CAP in recent years. This article reviews recent data regarding different treatments including antimicrobials and adjunctive therapies in patients with severe CAP.
University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
Combination antibiotic therapy improves survival in patients with community-acquired pneumonia and shock.
Rodríguez A, Mendia A, Sirvent JM, Barcenilla F, de la Torre-Prados MV, Solé-Violán J, Rello J, CAPUCI Study Group
Crit Care Med. 2007;35(6):1493.
OBJECTIVE: To assess whether combination antibiotic therapy improves outcome of severe community-acquired pneumonia in the subset of patients with shock.
DESIGN: Secondary analysis of a prospective observational, cohort study.
SETTING: Thirty-three intensive care units (ICUs) in Spain.
PATIENTS: Patients were 529 adults with community-acquired pneumonia requiring ICU admission.
MEASUREMENT AND MAIN RESULTS: Two hundred and seventy (51%) patients required vasoactive drugs and were categorized as having shock. The effects of combination antibiotic therapy and monotherapy on survival were compared using univariate analysis and a Cox regression model. The adjusted 28-day in-ICU mortality was similar (p = .99) for combination antibiotic therapy and monotherapy in the absence of shock. However, in patients with shock, combination antibiotic therapy was associated with significantly higher adjusted 28-day in-ICU survival (hazard ratio, 1.69; 95% confidence interval, 1.09-2.60; p = .01) in a Cox hazard regression model. Even when monotherapy was appropriate, it achieved a lower 28-day in-ICU survival than an adequate antibiotic combination (hazard ratio, 1.64; 95% confidence interval, 1.01-2.64).
CONCLUSIONS: Combination antibiotic therapy does not seem to increase ICU survival in all patients with severe community-acquired pneumonia. However, in the subset of patients with shock, combination antibiotic therapy improves survival rates.
Intensive Care Unit, Joan XXIII University Hospital, Tarragona, Spain.