Severe pneumococcal pneumonia: impact of new quinolones on prognosis

• Published in: BMC infectious diseases 2011-03, Vol.11 (1), p.66-66, Article 66
• Main Authors: Olive, David, Georges, Hugues, Devos, Patrick, Boussekey, Nicolas, Chiche, Arnaud, Meybeck, Agnes, Alfandari, Serge, Leroy, Olivier
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; Beta lactamases; beta-Lactams - therapeutic use; Blood pressure; Confidence intervals; Data collection; Dosage and administration; Drug dosages; Drug therapy; Drug therapy, Combination; Failure; Female; Hospitalization; Humans; Insulin; Male; Middle Aged; Mortality; Multivariate analysis; Patient outcomes; Pneumonia; Pneumonia, Pneumococcal; Pneumonia, Pneumococcal - drug therapy; Pneumonia, Pneumococcal - mortality; Pneumonia, Pneumococcal - pathology; Prognosis; Quinolone antibacterial agents; Quinolones; Quinolones - therapeutic use; Respiratory distress syndrome; Retrospective Studies; Sepsis; Standard deviation; Streptococcus infections; Streptococcus pneumoniae; Streptococcus pneumoniae - drug effects; Treatment Outcome; Ventilation
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/1471-2334-11-66

Most guidelines have been proposing, for more than 15 years, a β-lactam combined with either a quinolone or a macrolide as empirical, first-line therapy of severe community acquired pneumonia (CAP) requiring ICU admission. Our goal was to evaluate the outcome of patients with severe CAP, focusing on the impact of new rather than old fluoroquinolones combined with β-lactam in the empirical antimicrobial treatments. Retrospective study of consecutive patients admitted in a 16-bed general intensive care unit (ICU), between January 1996 and January 2009, for severe (Pneumonia Severity Index > or = 4) community-acquired pneumonia due to non penicillin-resistant Streptococcus pneumoniae and treated with a β-lactam combined with a fluoroquinolone. We included 70 patients of whom 38 received a β-lactam combined with ofloxacin or ciprofloxacin and 32 combined with levofloxacin. Twenty six patients (37.1%) died in the ICU. Three independent factors associated with decreased survival in ICU were identified: septic shock on ICU admission (AOR = 10.6; 95% CI 2.87-39.3; p = 0.0004), age > 70 yrs. (AOR = 4.88; 95% CI 1.41-16.9; p = 0.01) and initial treatment with a β-lactam combined with ofloxacin or ciprofloxacin (AOR = 4.1; 95% CI 1.13-15.13; p = 0.03). Our results suggest that, when combined to a β-lactam, levofloxacin is associated with lower mortality than ofloxacin or ciprofloxacin in severe pneumococcal community-acquired pneumonia.