Beta-Lactam Plus Macrolide for Patients Hospitalized With CommunityAcquired Pneumonia: Difference Between Autumn and Spring
10.3346/jkms.2022.37.e324
- Author:
Yoonjung KIM
1
;
Yena JEON
;
Ki Tae KWON
;
Sohyun BAE
;
Soyoon HWANG
;
Hyun-Ha CHANG
;
Shin-Woo KIM
;
Won Kee LEE
;
Ki-Hwa YANG
;
Ji-Hyeon SHIN
;
Eun-Kyung SHIM
Author Information
1. Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
- Publication Type:Original Article
- From:Journal of Korean Medical Science
2022;37(45):e324-
- CountryRepublic of Korea
- Language:English
-
Abstract:
Background:The 2017 Korean guideline on community-acquired pneumonia (CAP) recommended beta-lactam plus macrolide combination therapy for patients hospitalized with severe pneumonia, and beta-lactam monotherapy for mild-to-moderate pneumonia.However, antibiotic treatment regimen for mild-to-moderate CAP has never been evaluated for Korean patients.
Methods:In this retrospective cohort study, study patients were selected from three evaluation periods (October 1 to December 31, 2014; April 1 to June 30, 2016; October 1 to December 31, 2017) of the National Quality Assessment Program for CAP management and the National Health Insurance data on the selected patients was extracted from 1 year before the first patient enrollment and 1 year after the last patient enrollment at each evaluation period for the analysis of risk adjustment and outcomes. The survival rates between beta-lactam plus macrolide (BM) groups and beta-lactam monotherapy (B) were compared using a Kaplan-Meier survival analysis after propensity score matching by age, gender, confusion, urea, respiratory rate, blood pressure at age of 65 years or older (CURB-65), and Charlson comorbidity index for risk adjustment. The differences between autumn and spring season were also evaluated.
Results:A total of 30,053 patients were enrolled. Mean age and the male-to-female ratio were 64.7 ± 18.4 and 14,197:15,856, respectively. After matching, 2,397 patients in each group were analyzed. The 30-day survival rates did not differ between the BM and B groups (97.3% vs. 96.5%, P = 0.081). In patients with CURB-65 ≥ 2, the 30-day survival rate was higher in the BM than in the B group (93.7% vs. 91.0%, P = 0.044). Among patients with CURB-65 ≥ 2, the 30-day survival rate was higher in the BM than in the B group (93.3% vs. 88.5%, P = 0.009) during autumn season, which was not observed during spring (94.2% vs. 94.1%, P = 0.986).
Conclusion:Beta-lactam plus macrolide combination therapy shows potential as an empirical therapy for CAP with CURB-65 ≥ 2, especially in autumn.
