Between 2000 and 2013 there has been an increase in the early prescription of antibiotics and use of combination therapy in patients with pneumococcal pneumonia, researchers report.
These trends were associated with significant improvements in patient survival in the intensive care unit (ICU), the research shows.
“In view of these results, all patients with pneumococcal [severe community-acquired pneumonia] SCAP requiring ICU admission should receive early treatment and combined antibiotic therapy”, write Simone Gattarello (Vall d’Hebron University Hospital, Barcelona, Spain) and co-authors in Chest.
For their study, Gattarello and colleagues compared antibiotic prescribing practices in two prospective European cohorts. They matched 80 patients from the Community-Acquired Pneumonia en la Unidad de Cuidados Intensivos (CAPUCI) II study, which was conducted in 2008–2013, with 80 patients from CAPUCI I, which was conducted in 2000–2002.
All patients were admitted to hospital with SCAP caused by Streptococcus pneumoniae and the groups were matched for presence of shock at admission, need of mechanical ventilation, chronic obstructive pulmonary disease, immunosuppression and age.
The incidence of SCAP increased significantly over the study period, from 27.0% to 43.9%, the authors found. The estimated probability of death also increased, from 24.0% to 31.0%.
However, ICU mortality declined significantly, from 32.5% in 2000–2002 to 17.5% in 2008–2013, with an odds ratio (OR) of 0.82. This decline was also apparent in the subgroups of patients with shock (OR=0.67) and in those receiving mechanical ventilation (OR=0.73).
Over the same time period, antibiotic administration within 3 hours of hospitalisation increased from 27.5% to 70.0%. Furthermore, use of combination therapy – usually a cephalosporin and a macrolide antibiotic – rose from 66.2% to 87.5%.
Both changes were statistically significant and contributed to an increase in the proportion of patients whose treatment was guideline-compliant, from 47.5% to 80.0%.
Finally, multivariate analysis confirmed that invasive mechanical ventilation was a risk factor for ICU mortality (OR=5.23) whereas early antibiotic administration (OR=0.36) and combined therapy (OR=0.19) protected against ICU mortality.
“The main finding of this study was a 15% decrease in ICU mortality due to SCAP caused by S pneumoniae during the study period,” the team concludes. “Several changes in antibiotic prescription practices were detected, and an association between improved survival and both earlier antibiotic administration and increased combined antibiotic therapy was identified.”
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