Sezai TAŞBAKAN, Ayşın ŞAKAR COŞKUN, Uğur BİLGE, Abdullah SAYINER, Aykut ÇİLLİ, Öznur KILIÇ, Yavuz HAVLUCU, Fatma TOKGÖZ, Anıl AKTAŞ SAMUR, Grant W. WATERER, Oğuz KILINÇ, Armağan HAZAR, Burcu ÇELENK

Antibiotic treatment outcomes in community-acquired pneumonia

Background/aim: The optimal empiric antibiotic regimen for patients with community-acquired pneumonia (CAP) remains unclear.This study aimed to evaluate the clinical cure rate, mortality, and length of stay among patients hospitalized with communityacquired pneumonia in nonintensive care unit (ICU) wards and treated with a β-lactam, β-lactam and macrolide combination, or afluoroquinolone.Materials and methods: This prospective cohort study was performed using standardized web-based database sheets from January 2009to September 2013 in nine tertiary care hospitals in Turkey.Results: Six hundred and twenty-one consecutive patients were enrolled. A pathogen was identified in 78 (12.6%) patients. The mostfrequently isolated bacteria were S. pneumoniae (21.8%) and P. aeruginosa (19.2%). The clinical cure rate and length of stay were notdifferent among patients treated with β-lactam, β-lactam and macrolide combination, and fluoroquinolone. Forty-seven patients (9.2%)died during the hospitalization period. There was no difference in survival among the three treatment groups.Conclusion: In patients admitted to non-ICU hospital wards for CAP, there was no difference in clinical outcomes between β-lactam,β-lactam and macrolide combination, and fluoroquinolone regimens.

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Van der Eerden MM, Vlaspolder F, de Graaff CS, Groot T, Bronsveld W, Jansen HM, Boersma WG. Comparison between pathogen directed antibiotic treatment and empirical broad spectrum antibiotic treatment in patients with community acquired pneumonia: a prospective randomised study. Thorax 2005; 60: 672-678.
Lim WS, Baudouin SV, George RC, Hill AT, Jamieson C, Le Jeune I, Macfarlane JT, Read RC, Roberts HJ, Levy ML et al. BTS guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax 2009; 64: 1-55.
Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM Jr, Musher DM, Niederman MS et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007; 44: 27-72.
Woodhead M, Blasi F, Ewig S, Garau J, Huchon G, Ieven M, Ortqvist A, Schaberg T, Torres A, van der Heijden G et al. Guidelines for the management of adult lower respiratory tract infections – full version. Clin Microbiol Infec 2011; 17: 1-59.
Postma DF, van Werkhoven CH, van Elden LJ, Thijsen SF, Hoepelman AI, Kluytmans JA, Boersma WG, Compaijen CJ, van der Wall E, Prins JM et al. CAP-START Study Group. Antibiotic treatment strategies for community-acquired pneumonia in adults. New Engl J Med 2015; 372: 1312-1323.
Eliakim-Raz N, Robenshtok E, Shefet D, Gafter-Gvili A, Vidal L, Paul M, Leibovici L. Empiric antibiotic coverage of atypical pathogens for community-acquired pneumonia in hospitalized adults. Cochrane Db Syst Rev 2012; 9: CD004418.
Asadi L, Sligl WI, Eurich DT, Colmers IN, Tjosvold L, Marrie TJ, Majumdar SR. Macrolide-based regimens and mortality in hospitalized patients with community-acquired pneumonia: a systematic review and meta-analysis. Clin Infect Dis 2012; 55: 371-380.
Sligl WI, Asadi L, Eurich DT, Tjosvold L, Marrie TJ, Majumdar SR. Macrolides and mortality in critically ill patients with community-acquired pneumonia: a systematic review and meta-analysis. Crit Care Med 2014; 42: 420-432.
Nie W, Li B, Xiu Q. β-Lactam/macrolide dual therapy versus β-lactam monotherapy for the treatment of communityacquired pneumonia in adults: a systematic review and metaanalysis. J Antimicrob Chemoth 2014; 69: 1441-1446.
Rodrigo C, McKeever TM, Woodhead M, Lim WS. Single versus combination antibiotic therapy in adults hospitalised with community acquired pneumonia. Thorax 2013; 68: 493- 495.
Garin N, Genné D, Carballo S, Chuard C, Eich G, Hugli O, Lamy O, Nendaz M, Petignat PA, Perneger T et al. β-Lactam monotherapy vs β-lactam-macrolide combination treatment in moderately severe community-acquired pneumonia: A randomized noninferiority trial. JAMA Intern Med 2014; 174: 1894-1901.
Blasi F, Iori I, Bulfoni A, Corrao S, Costantino S, Legnanie D. Can CAP guideline adherence improve patient outcome in internal medicine departments? Eur Respir J 2008; 32: 902-910.
Reyes Calzada S, Martínez Tomas R, Cremades Romero MJ, Martínez Moragón E, Soler Cataluña JJ, Menéndez Villanueva R. Empiric treatment in hospitalized community-acquired pneumonia. Impact on mortality, length of stay and readmission. Respir Med 2007; 101: 1909-1915.
Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, Coley CM, Marrie TJ, Kapoor WN. A prediction rule to identify low-risk patients with community-acquired pneumonia. New Engl J Med 1997; 336: 243-250.
Lim WS, van der Eerden MM, Laing R, Boersma WG, Karalus N, Town GI, Lewis SA, Macfarlane JT. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 2003; 58: 377-382.
Mills GD, Oehley MR, Arrol B. Effectiveness of beta lactam antibiotics compared with antibiotics active against atypical pathogens in non-severe community acquired pneumonia: meta-analysis. BMJ Brit Med J 2005; 330: 456.
Lee JS, Giesler DL, Gellad WF, Fine MJ. Antibiotic therapy for adults hospitalized with community-acquired pneumonia. A systematic review. JAMA-J Am Med Assoc 2016; 315: 593-602.
Bender MT, Niederman MS. Lessons learned from 2 decades of CAP therapy data: ways to improve patient management. J Thorac Dis 2016; 8: 6.
Horita N, Otsuka T, Haranaga S, Namkoong H, Miki M, Miyashita N, Higa F, Takahashi H, Yoshida M, Kohno S et. al. Beta-lactam plus macrolides or beta-lactam alone for community-acquired pneumonia: a systematic review and meta-analysis. Respirology 2016; doi: 10.1111/resp.12835.
Raz-Pasteur A, Shasha D, Paul M. Fluoroquinolones or macrolides alone versus combined with β-lactams for adults with community-acquired pneumonia: Systematic review and meta-analysis. Int J Antimicrob Ag 2015; 46: 242-248.
Borg MA, Tiemersma E, Scicluna E, van de Sande-Bruinsma N, de Kraker M, Grundmann H. Prevalence of penicillin and erythromycin resistance among invasive Streptococcus pneumoniae isolates reported by laboratories in the southern and eastern Mediterranean region. European Society of Clinical Microbiology and Infectious Diseases 2009; 15: 232-237.
Zarakolu P, Soyletir G, Gur D, Unal S. Antimicrobial resistance patterns of respiratory pathogens: a local report from Turkey. Clin Microbiol Infect 2003; 9: 1257-1258.
Torumkuney D, Gur D, Soyletir G, Gurler N, Aktas Z, Sener B, Tunger A, Bayramoglu G, Koksal I, Yalcin AN et al. Results from the survey of antibiotic resistance (SOAR) 2002–2009 in Turkey. J Antimicrob Chemoth 2016; 71: 85-91.
Gündüz C, Taşbakan MS, Sayıner A, Çilli A, Kılınç O, Şakar Coşkun A. Factors affecting treatment success in communityacquired pneumonia. Turk J Med Sci 2016; 46: 1469-1474.