1238. Clinical Failure Rates with and without Atypical Coverage in Hospitalized Adults with Community-Acquired Pneumonia: A Meta-analysis
Session: Poster Abstract Session: Clinical Infectious Diseases: Respiratory Infections
Friday, October 28, 2016
Room: Poster Hall
  • CAP_Metaanalysis.pdf (513.1 kB)
  • Empiric Therapy by Regimens with and without Coverage of Atypical Bacteria in Hospitalized adults with Community-Acquired Pneumonia: Meta-analysis


    Both typical and atypical organisms can cause community-acquired pneumonia (CAP); however, the need for atypical coverage remains unclear. Prior meta-analyses of randomized controlled trials (RCTs) have not demonstrated the benefit of atypical coverage; but included studies of non-recommended comparators and/or added atypical coverage between agents with different typical coverage. One meta-analysis favoring atypical coverage did not include RCTs. Objectives of this meta-analysis were 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) and mortality (secondary endpoint).


    We searched the PubMed, EMBASE and Cochrane databases for relevant RCTs of hospitalized CAP adults; without date restrictions and limiting languages to English, Arabic, French, German, Spanish, Italian, and Dutch. Five RCTs with a total of 2,011 pts were retained. We estimated risk ratios (RRs) with 95% confidence intervals (CIs) using random-effects models and assessed for consistency (I2).


    998 patients treated with empiric atypical bacterial coverage were compared to 1013 patients treated with non-atypical bacterial coverage. 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%) (see figure). Mortality rates did not differ between treatment arms (RR=0.869, 95% CI 0.567-1.332, p=0.52, I2=0%).


    Our meta-analysis showed that empiric atypical coverage is associated with a 14.9% reduction of clinical failure in hospitalized adults with CAP. No significant differences were found in terms of mortality.

    Khalid Eljaaly, PharmD, CAPPS, BCPS1,2, Samah Alshehri, PharmD, CAPPS, BCPS1,2, Ahmed Aljabri, PharmD1,2, Ivo Abraham, PhD1,3 and David Nix, PharmD3, (1)HOPE Center, University of Arizona, Tucson, AZ, (2)King Abdulaziz University, Jeddah, Saudi Arabia, (3)University of Arizona College of Pharmacy, Tucson, AZ


    K. Eljaaly, None

    S. Alshehri, None

    A. Aljabri, None

    I. Abraham, None

    D. Nix, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.