A Hypothesis-Generating Study of the Combination of Aspirin plus Macrolides in Patients with Severe Community-Acquired Pneumonia.
Aged
Aged, 80 and over
Anti-Bacterial Agents
/ therapeutic use
Anti-Inflammatory Agents, Non-Steroidal
/ therapeutic use
Aspirin
/ therapeutic use
China
Community-Acquired Infections
/ drug therapy
Drug Therapy, Combination
Female
Humans
Italy
Japan
Macrolides
/ therapeutic use
Male
Pneumonia, Bacterial
/ drug therapy
Survival Rate
Treatment Outcome
United States
aspirin
community-acquired pneumonia
macrolides
septic shock
severe pneumonia
Journal
Antimicrobial agents and chemotherapy
ISSN: 1098-6596
Titre abrégé: Antimicrob Agents Chemother
Pays: United States
ID NLM: 0315061
Informations de publication
Date de publication:
02 2019
02 2019
Historique:
received:
24
07
2018
accepted:
25
10
2018
pubmed:
5
12
2018
medline:
6
2
2020
entrez:
5
12
2018
Statut:
epublish
Résumé
While the inflammatory response to severe pneumonia is paramount in limiting and resolving the infection, excessive inflammation can lead to deleterious effects. We theorized that patients with severe community-acquired pneumonia (CAP) who were treated with macrolides and aspirin would receive benefit beyond that of conventional antibiotic therapy. An observational study was conducted with patients with severe CAP. All patients were admitted to 5 teaching hospitals (in Italy, the United States, Japan, and China), and data were gathered from their electronic medical records. Severe pneumonia was defined according to Infectious Diseases Society of America/American Thoracic Society criteria. Patients were divided into 4 groups, i.e., (i) the aspirin-only group (ASG), (ii) the macrolide-only group (MG), (iii) the aspirin plus macrolide group (ASMG), or (iv) the neither aspirin nor macrolide group (NASMG). Survival rates for the 4 groups were evaluated after adjustment for confounders and after weighting by propensity score. A total of 1,295 patients were included in the analysis. There were 237 patients (18.3%) in the ASG, 294 (22.7%) in the MG, 148 (11.4%) in the ASMG, and 616 (47.6%) in the NASMG. The mortality rate at 30 days was 15.5% in the ASMG, compared to 28.2% in the NASMG, 23.8% in the MG, and 21.1% in the ASG. After propensity score analysis, receipt of aspirin plus macrolide (hazard ratio, 0.71 [95% confidence interval, 0.58 to 0.88];
Identifiants
pubmed: 30509940
pii: AAC.01556-18
doi: 10.1128/AAC.01556-18
pmc: PMC6355605
pii:
doi:
Substances chimiques
Anti-Bacterial Agents
0
Anti-Inflammatory Agents, Non-Steroidal
0
Macrolides
0
Aspirin
R16CO5Y76E
Types de publication
Journal Article
Multicenter Study
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2019 American Society for Microbiology.
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