Vol - 25, Issue - 4
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[This article belongs to Volume - 25, Issue - 4]
International Medical Journal
Journal ID : IMJ-15-03-2020-347
Total View : 162

Abstract : Community-acquired pneumonia (CAP) is a common disease with a high hospitalization and mortality rate. The choice of appropriate empirical antibiotic treatment is still a matter of debate. The aim of the study was to analyze the prevalence of different antibiotic regimens and their impact on clinical outcome in hospitalized patients with CAP and to assess the impact of the corticosteroids on the in-hospital mortality. 1292 consecutive patients hospitalized at the Clinic of Pneumonology and Phthisiatrics of UMHAT “Saint Marina” – Varna were retrospectively studied for the period 2012 to 2015. The in-hospital mortality was 11.5%. The severity of pneumonia was assessed by CURB-65. The most commonly used therapeutic regimens were: beta-lactam monotherapy (34%), beta-lactam/fluoroquinolone combination (33.1%), and beta-lactam/macrolide combination (23.5%). The combination of beta-lactam/macrolide was associated with the lowest in-hospital mortality rate - 4.8%; OR 0.45 (95% CI 0.25-0.8), p <0.001, lowest rate of treatment failure (15.4%), p<0.001 and shortest hospital stay (7.76 ± 2.82 days). In severe CAP (CURB≥3), this combination showed  significantly lower in-hospital mortality of 33.3%, whereas the mortality on beta-lactam/fluoroquinolone combination  was 50% (p <0.001). The treatment failure was significantly associated with increased in-hospital mortality (16.7% vs. 6.8%, OR 2.76 (95% CI 1.83-4.16), p <0.001. There was no significant difference in mortality rate between patients treated with or without corticosteroids (7.9% vs 8.9%, p> 0.05). The combination of beta-lactam/macrolide was associated with better clinical outcomes. The choice of appropriate  initial antibiotic treatment is crucial for the prognosis

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