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Does the selection of narrow- or broad-spectrum betalactam antibiotics have any different effect in mortality of pneumococcal pneumonia?: – a retrospective register study
Örebro University, School of Medical Sciences.
2019 (English)Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
Abstract [en]

Introduction: Streptococcus pneumoniae (pneumococci) is most common and has the highest mortality in community-acquired pneumonia (CAP). In vitro many antibiotics are effective against pneumococci, but recent studies suggest a favor for narrow-spectrum antibiotics.

Aim: To investigate difference in mortality from pneumococcal CAP if betalactam antibiotics in monotherapy with a narrow or broad spectrum are selected initially.

Methods: A retrospective national register study with cases of pneumococcal CAP 2008-2015. Cohorts of CAP were divided by severety, 0-2 and 3-4 CRB-65-points. Antibiotics and background factors were analyzed. A logistic regression model analyzed potential factors for mortality <30 days.

Results: There were 34.299 cases, of which 1592 cases were included, n=1509 with 0-2 CRB-65 and n=83 with 3-4 CRB-65. Overall mortality was 2.5%. 17 out of 1025 (1.7%) died after narrow-spectrum betalactam monotherapy (NSBM), and 23 out of 567 (4.1%) died after broad-spetrum betalactam monotherapy (BSBM). In CAP with 0-2 CRB-65-points, NSBM were associated with less mortality than BSBM (p=0.007, OR 0.39; 95 % CI 0.20-0.78). Age<65 and kidney disease were associated with higher mortality, but in the logistic regression model, these factors were not associated with selected antibiotics and thus not confounders. In CAP with 3-4 CRB-65-points, no significant results were found.

Conclusion: NSBM, like penicillins, seems to be safe choice and associated with less mortality than BSBM in less severe pneumococcal CAP. The reasons are unknown, but maybe because of less severe side-effects, better property to the bacteria or better empirical dosage.

Place, publisher, year, edition, pages
2019.
Keywords [en]
Pneumococci, betalactam antibiotics, pneumoniae, CAP, mortality
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:oru:diva-74019OAI: oai:DiVA.org:oru-74019DiVA, id: diva2:1313477
Subject / course
Medicine
Supervisors
Examiners
Available from: 2019-05-03 Created: 2019-05-03 Last updated: 2019-05-03Bibliographically approved

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