In patients with severe community-acquired pneumonia (CAP), the use of combination antibiotic therapy that includes a macrolide is the only strategy that appears to improve hospital length of stay and 6-month mortality rates.
A post hoc analysis of a Portuguese prospective observational multicenter study published in the Journal of Critical Care evaluated the effect of various aspects of antibiotic therapy on outcomes among critically ill patients with CAP.
A total of 502 patients with CAP were enrolled in this analysis of the INFAUCI (Infection on Admission to the ICU [intensive care unit]) study. The mean patient age was 58±17 years, and 66% (332 of 502) of the participants were men. Patients scored 46±18 on the Simplified Acute Physiology Score II. Overall, 76% (381 of 502) of the participants received combination antibiotic therapy, which consisted primarily of a beta-lactam plus a macrolide in 80% (305 of 381) of these individuals. An antipseudomonal antibiotic was used to treat approximately one third of the participants. The use of antibiotic therapy was deemed inappropriate in 16% of all cases of microbiologically documented CAP (n=177).
Hospital and 6-month mortality rates were 34% and 35%, respectively. According to adjusted multivariate logistic regression analysis, combination antibiotic treatment that included a macrolide was independently associated with reduced length of hospital stay (odds ratio, [OR], 0.17; 95% CI, 0.06-0.51) and 6-month mortality rates (OR, 0.21; 95% CI, 0.07-0.57). Prolonged antibiotic use (>7 days) was associated with a significantly longer stay in the ICU (14 days vs 7 days; P< .001) and a significantly longer duration of hospital stay (25 days vs 17 days; P< .001).
The results suggest that combination antibiotic treatment containing a macrolide is the most appropriate therapeutic strategy in terms of improvement in both short-term and long-term outcomes in patients with severe CAP. However, the use of antibiotic therapy for >7 days in these patients did not confer any additional survival benefits.
Pereira JM, Gonçalves-Pereira J, Ribeiro O, Baptista JP, Froes F, Paiva JA. Impact of antibiotic therapy in severe community-acquired pneumonia: data from the Infauci study. J Crit Care. 2017;43:183-189.