Chest
Original Research: Lung InfectionAntibiotics for Bacteremic Pneumonia: Improved Outcomes With Macrolides but Not Fluoroquinolones
Section snippets
Materials and Methods
The data analyzed were part of the Medicare National Pneumonia Project, which is a component of the Medicare Quality Improvement Program. Therefore, neither informed consent nor institutional review board approval were required. Eligible patients were fee-for-service Medicare beneficiaries who had been discharged from the hospital between 1998 and 2001 with a principal diagnosis of pneumonia, and those with a principal diagnosis of septicemia or respiratory failure and a secondary diagnosis of
Results
A total of 2,349 episodes of bacteremic pneumonia from two sampling periods (1998 to 1999 and 2000 to 2001) were considered for inclusion in the study. Fifty-three episodes were excluded because of missing data elements, 26 because either an atypical pathogen or fungemia was identified, and 61 because antibiotic therapy was not started within 24 h of admission to the hospital. This left 2,209 cases, 1,140 from the 1998-to-1999 sampling period and 1,069 from the 2000-to-2001 sampling period.
Discussion
We have demonstrated that several factors are independently associated with improved outcomes in Medicare patients with bacteremic pneumonia. Severity of illness and concordant initial antibiotic therapy were predictive of outcomes. More noteworthy was the finding that treatment with a macrolide, but not with a fluoroquinolone, was independently associated with lower mortality rates and a lower 30-day hospital readmission rate. In contrast to some studies,17, 23but not all prior studies,7, 24
Acknowledgments
The authors wish to thank David Dorsky, MD, and Thomas Meehan, MD, MPH, for kindly reviewing the manuscript.
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The analyses on which this publication is based were performed under contract No. 500–02-OK-03, funded by the Centers for Medicare & Medicaid Services, an agency of the US Department of Health and Human Services. The content of this publication does not necessarily reflect the views of the policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government. The authors assume full responsibility for the accuracy and completeness of the ideas presented.
Dr. Metersky has served on an advisory board/speaker's bureau for the following pharmaceutical companies: Aventis; Bayer; Ortho; Oscient; and Pfizer. The other authors of the article have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).