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dc.contributor.advisorNix, David E.en
dc.contributor.authorEljaaly, Khalid
dc.creatorEljaaly, Khaliden
dc.date.accessioned2017-06-13T23:11:59Z
dc.date.available2017-06-13T23:11:59Z
dc.date.issued2017
dc.identifier.urihttp://hdl.handle.net/10150/624097
dc.description.abstractBackground: Both typical and atypical bacteria can cause community-acquired pneumonia (CAP); however, the need for empiric atypical coverage remains controversial. Our objective was to evaluate the impact of antibiotic regimens with atypical coverage (a fluoroquinolone or combination of a macrolide/doxycycline with a β-lactam) to a regimen without atypical antibiotic coverage (β-lactam monotherapy) on rates of clinical failure (primary endpoint), mortality, bacteriologic failure, and adverse events, (secondary endpoints). Methods: We searched the PubMed, EMBASE and Cochrane Library databases for relevant randomized clinical trials of hospitalized CAP adults. We estimated risk ratios (RRs) with 95% confidence intervals (CIs) using a fixed-effect model, but used a random-effects model if significant heterogeneity (I2) was observed. Results: Five RCTs with a total of 2,011 patients were retained. A statistically significant lower clinical failure rate was observed with empiric atypical coverage (RR, 0.851 [95% CI, 0.732-0.99; P=0.037]; I2=0%). The secondary outcomes did not differ between the two study groups: mortality (RR=0.549 [95% CI, 0.259-1.165, P=0.118], I2=61.434%) bacteriologic failure (RR=0.816 [95% CI, 0.523-1.272, P=0.369], I2=0%), diarrhea (RR=0.746 [95% CI, 0.311-1.790, P=0.512], I2=65.048%), and adverse events requiring antibiotic discontinuation (RR=0.83 [95% CI, 0.542-1.270, P=0.39], I2=0%). Conclusions: Empiric atypical coverage was associated with a significant reduction in clinical failure in hospitalized adults with CAP. Reduction in mortality, bacterial failure, diarrhea, and discontinuation due to adverse effects were not significantly different between groups, but all estimates favored atypical coverage. Our findings provide support for the current guidelines recommendations to include empiric atypical coverage.
dc.language.isoen_USen
dc.publisherThe University of Arizona.en
dc.rightsCopyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.en
dc.titleBenefit of Empiric Atypical Bacterial Coverage in Hospitalized Adults with Community-Acquired Pneumonia: A Systematic Review and Meta-Analysisen_US
dc.typetexten
dc.typeElectronic Thesisen
thesis.degree.grantorUniversity of Arizonaen
thesis.degree.levelmastersen
dc.contributor.committeememberNix, David E.en
dc.contributor.committeememberAbraham, Ivoen
dc.contributor.committeememberAl Mohajer, Mayaren
dc.description.releaseThesis not available (per author's request)en
thesis.degree.disciplineGraduate Collegeen
thesis.degree.disciplineClinical Translational Sciencesen
thesis.degree.nameM.S.en
html.description.abstractBackground: Both typical and atypical bacteria can cause community-acquired pneumonia (CAP); however, the need for empiric atypical coverage remains controversial. Our objective was to evaluate the impact of antibiotic regimens with atypical coverage (a fluoroquinolone or combination of a macrolide/doxycycline with a β-lactam) to a regimen without atypical antibiotic coverage (β-lactam monotherapy) on rates of clinical failure (primary endpoint), mortality, bacteriologic failure, and adverse events, (secondary endpoints). Methods: We searched the PubMed, EMBASE and Cochrane Library databases for relevant randomized clinical trials of hospitalized CAP adults. We estimated risk ratios (RRs) with 95% confidence intervals (CIs) using a fixed-effect model, but used a random-effects model if significant heterogeneity (I2) was observed. Results: Five RCTs with a total of 2,011 patients were retained. A statistically significant lower clinical failure rate was observed with empiric atypical coverage (RR, 0.851 [95% CI, 0.732-0.99; P=0.037]; I2=0%). The secondary outcomes did not differ between the two study groups: mortality (RR=0.549 [95% CI, 0.259-1.165, P=0.118], I2=61.434%) bacteriologic failure (RR=0.816 [95% CI, 0.523-1.272, P=0.369], I2=0%), diarrhea (RR=0.746 [95% CI, 0.311-1.790, P=0.512], I2=65.048%), and adverse events requiring antibiotic discontinuation (RR=0.83 [95% CI, 0.542-1.270, P=0.39], I2=0%). Conclusions: Empiric atypical coverage was associated with a significant reduction in clinical failure in hospitalized adults with CAP. Reduction in mortality, bacterial failure, diarrhea, and discontinuation due to adverse effects were not significantly different between groups, but all estimates favored atypical coverage. Our findings provide support for the current guidelines recommendations to include empiric atypical coverage.


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