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Effect of β-Lactam Plus Macrolide Versus Fluoroquinolone on 30-Day Readmissions for Community-Acquired Pneumonia

Gilbert, Travis T. PharmD1; Arfstrom, Rachel J. PharmD, RPh*,1; Mihalovic, Scott W. PharmD1; Dababneh, Ala S. MD2,3; Varatharaj Palraj, Bharath Raj MBBS2,3; Dierkhising, Ross A. MS4; Mara, Kristin C. MS3,4; Lessard, Sarah R. PharmD, RPh1

doi: 10.1097/MJT.0000000000000788
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Background: Antibiotic therapy with a macrolide and β-lactam or a fluoroquinolone for the empirical treatment of community-acquired pneumonia (CAP) in an inpatient non–intensive care setting is recommended per guidelines. Studies show that these treatments have similar outcomes, including death, adverse effects, and bacterial eradication. However, a comparison of 30-day readmission rates between these treatments is limited.

Study Question: To determine whether 30-day readmissions for patients treated for CAP in a regional hospital differed between a fluoroquinolone monotherapy and a β-lactam plus macrolide combination therapy.

Study Design: Retrospective cohort study of patients aged ≥18 years with a CAP diagnosis who were admitted to the same regional hospital from December 1, 2011, through December 1, 2016.

Measures and Outcomes: Patients receiving a third-generation cephalosporin plus macrolide were compared with those receiving a respiratory fluoroquinolone. Exclusion criteria were concurrent or recent use of the study antibiotics; death, transfer, or transition to hospice; and diagnosis of hospital-acquired pneumonia or health care–associated pneumonia. The collected data were 30-day readmission rates, antibiotic regimens, demographic characteristics, and pneumonia severity index and comorbidity scores. Association between treatment group and readmissions was assessed with logistic regression. Association between readmissions and individual data points between the 2 treatment groups was calculated with multivariate regression and odds ratio (95% confidence interval).

Results: Of 432 patients, 171 met inclusion criteria (fluoroquinolone group, n = 101; β-lactam plus macrolide group, n = 70). Thirty-day readmissions were not significantly different between the fluoroquinolone group and β-lactam plus macrolide group (P = 0.58). Increased 30-day readmissions were independently associated with male sex and hospital length of stay (P < 0.05). Length of stay was approximately 3 days and did not differ between treatment groups.

Conclusions: No difference was seen in 30-day readmissions between CAP patients who received fluoroquinolone monotherapy and those who received β-lactam plus macrolide combination therapy.

1Pharmacy, Mayo Clinic Health System, Franciscan Healthcare in La Crosse, La Crosse, WI;

2Division of Infectious Diseases, Mayo Clinic Health System, Franciscan Healthcare in La Crosse, La Crosse, WI;

3Division of Infectious Diseases, Mayo Clinic, Rochester, MN; and

4Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.

Address for correspondence: Pharmacy, Mayo Clinic Health System, Franciscan Healthcare in La Crosse, 700 West Avenue South, La Crosse, WI 54601. Email: arfstrom.rachel@mayo.edu

The authors have no conflicts of interest to declare.

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