Addition of a macrolide to a b-Lactam–Based empirical antibiotic regimen Is associated with lower in-hospital mortality for patients with bacteremic pneumococcal pneumonia

Abstract

To assess the association between inclusion of a macrolide in a b-lactam–based empirical antibiotic regimen and mortality among patients with bacteremic pneumococcal pneumonia, 10 years of data from a database were analyzed. The total available set of putative prognostic factors was subjected to stepwise logistic regression, with in-hospital death as the dependent variable. Of the 409 patients analyzed, 238 (58%) received a b-lactam plus a macrolide and 171 (42%) received a b-lactam without a macrolide. Multivariate analysis revealed 4 variables to be independently associated with death: shock ( ), age of 65 years ( ), infectionsP ! .0001 P .02 with pathogens that have resistance to both penicillin and erythromycin ( ), and no inclusion of aP p .04 macrolide in the initial antibiotic regimen ( ). For patients with bacteremic pneumococcal pneumonia,P p .03 not adding a macrolide to a b-lactam–based initial antibiotic regimen is an independent predictor of inhospital mortality. However, only a randomized study can definitively determine whether this association is due to a real effect of macrolides.