Severe community‐acquired pneumonia treated with β‐lactam–respiratory quinolone vs. β‐lactam–macrolide combination

Background This study aimed to compare the outcome of patients with severe community‐acquired pneumonia ( SCAP ) treated with the combination of either β‐lactam–quinolone (β Q ) or β‐lactam–macrolide (β M ) antibiotics. Methods We retrospectively studied a cohort of patients with SCAP treated from J anuary 2000 to D ecember 2010 at a mixed university‐level intensive care unit ( ICU ). APACHE II score, SCAP severity assessed by IDSA / ATS score, first antibiotic treatment initiated during the initial 24 h of admission, ICU and hospital length of stay ( LOS ), and ICU , hospital, 30 and 60‐day mortalities were assessed. Results Altogether, 210 patients with SCAP were analyzed, 104 in the β Q arm and 106 in the β M arm. Median APACHE II scores on admission were higher in the β M group (22 vs. 18, P = 0.003). More patients in the β Q group required mechanical ventilation (63.1% vs. 42.5%, P = 0.004) and fulfilled IDSA / ATS SCAP criteria ( n = 87; 83.7%) than those in the β M group ( n = 73; 68.9%; P = 0.015). Thirty‐day mortality was 16.3% in the β Q group and 24.5% in the βM group ( P = 0.17), and with septic shock mortality was 19.6% and 32.6%, respectively ( P = 0.16). On APACHE II and IDSA / ATS SCAP score adjusted multivariate logistic regression analysis, the βM group had a slightly higher but not significant odds ratio ( OR ) for a 30‐day mortality compared to the β Q group ( OR 1.4; 95% CI , 0.62–3.0; P = 0.44). Conclusion Thirty‐day mortality rate of SCAP patients did not differ whether they were treated with either β Q or β M combination.