Previous studies showed that in patients with bacteremic pneumococcal pneumonia the use of combination (CT) antibiotic (ABX) therapy was associated with lower mortality as compared to monotherapy (MT). Limited data is available based on the different degrees of severity of illness in patients with CAP. Our aim was to compare the use of empiric MT vs. CT therapy in hospitalized patients with CAP.
A retrospective, observational review of admitted patients with radiological confirmed CAP at two teaching hospitals in San Antonio, Texas. Severity of illness was quantified using the pneumonia severity index (PSI). Only those patients classified as PSI classes IV and V were included. The patients were divided in two groups depending on the initial empiric therapy (first 48 hours): MT vs. CT (≥ 2 ABX). Descriptive analyses were performed with a p-value 0.05 considered statistically significant.
A total of 119 patients had MT and 123 had CT. In MT patients with CAP, the mean age was older (71±12 years vs. 65±13). In addition, there were more Hispanic whites in the MT group (63% vs. 41%, p=0.01). The two groups had similar severity of illness with mean PSI scores of 115 and 111±33. However patients who were admitted to the ICU had a tendency toward more CT (61% vs. 39% [p=0.06]). There were no statistically significant differences in common processes of care parameters. CT was significantly more likely to be concordant with national guidelines (93% vs. 82%, p<0.01). Although the 30-day mortality rates for the CT group tended to be lower, there were no statistically significant differences between the two groups (13% vs. 18%).CONCLUSIONS: There were significant differences in some clinical characteristics of patients receiving MT vs. those receiving CT. Mortality was similar in both treatment groups despite the severity of illness.
Further study is warranted to determine the association between MT and CT in patients with severe CAP.
M.I. Restrepo, None.