PMID- 28267637
OWN - NLM
STAT- MEDLINE
DCOM- 20180420
LR  - 20180420
IS  - 1469-0691 (Electronic)
IS  - 1198-743X (Linking)
VI  - 23
IP  - 9
DP  - 2017 Sep
TI  - Levofloxacin versus azithromycin for treating legionella pneumonia: a propensity 
      score analysis.
PG  - 653-658
LID - S1198-743X(17)30127-1 [pii]
LID - 10.1016/j.cmi.2017.02.030 [doi]
AB  - OBJECTIVES: Concerns have arisen regarding the equivalence of levofloxacin and 
      some macrolides for treating community-acquired legionella pneumonia (LP). We 
      aimed to compare the outcomes of current patients with LP treated with 
      levofloxacin, azithromycin and clarithromycin. METHODS: Observational 
      retrospective multicentre study of consecutive patients with LP requiring 
      hospitalization (2000-2014) conducted in two hospitals. The primary outcome 
      assessed was 30-day mortality. To control for confounding, therapy was assessed 
      by multivariate analysis. RESULTS: We documented 446 patients with LP, of which 
      175 were treated with levofloxacin, 177 with azithromycin and 58 with 
      clarithromycin. No significant differences in time to defervescence (2 
      (interquartile range (IQR) 1-4) versus 2 (IQR 1-3) days; p 0.453), time to 
      achieve clinical stability (3 (2-5) versus 3 (2-5) days; p 0.486), length of 
      intravenous therapy (3 (2-5.25) versus 4 (3-6) days; p 0.058) and length of 
      hospital stay (7 (5-10) versus 6 (5-9) days; p 0.088) were found between patients 
      treated with levofloxacin and those treated with azithromycin. Patients treated 
      with clarithromycin had longer intravenous antibiotic treatment (3 (2-5.25) 
      versus 5 (3-6.25) days; p 0.002) and longer hospital stay (7 (5-10) versus 9 
      (7-14) days; p 0.043) compared with those treated with levofloxacin. The overall 
      mortality was 4.3% (19 patients). Neither univariate nor multivariate analysis 
      showed a significant association of levofloxacin versus azithromycin on mortality 
      (4 (2.3%) versus 9 (5.1%) deaths; p 0.164). The results did not change after 
      incorporation of the propensity score into the models. CONCLUSIONS: In our study, 
      no significant differences in most outcomes were found between patients treated 
      with levofloxacin and those treated with azithromycin. Due to the small number of 
      deaths, results regarding mortality should be interpreted with caution.
CI  - Copyright (c) 2017 European Society of Clinical Microbiology and Infectious 
      Diseases. Published by Elsevier Ltd. All rights reserved.
FAU - Garcia-Vidal, C
AU  - Garcia-Vidal C
AD  - Hospital Universitari de Bellvitge, IDIBELL (Institut D'investigacio Biomedica de 
      Bellvitge), Universitat de Barcelona, Barcelona, Spain; REIPI (Spanish Network 
      for the Research in Infectious Diseases), Instituto de Salud Carlos III, Madrid, 
      Spain. Electronic address: carolgv75@hotmail.com.
FAU - Sanchez-Rodriguez, I
AU  - Sanchez-Rodriguez I
AD  - Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, 
      Barcelona, Spain.
FAU - Simonetti, A F
AU  - Simonetti AF
AD  - Hospital Universitari de Bellvitge, IDIBELL (Institut D'investigacio Biomedica de 
      Bellvitge), Universitat de Barcelona, Barcelona, Spain.
FAU - Burgos, J
AU  - Burgos J
AD  - Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, 
      Barcelona, Spain.
FAU - Viasus, D
AU  - Viasus D
AD  - Hospital Universitari de Bellvitge, IDIBELL (Institut D'investigacio Biomedica de 
      Bellvitge), Universitat de Barcelona, Barcelona, Spain; Health Science Division, 
      Universidad del Norte and Hospital Universidad del Norte, Barranquilla, Colombia.
FAU - Martin, M T
AU  - Martin MT
AD  - Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, 
      Barcelona, Spain.
FAU - Falco, V
AU  - Falco V
AD  - Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, 
      Barcelona, Spain.
FAU - Carratala, J
AU  - Carratala J
AD  - Hospital Universitari de Bellvitge, IDIBELL (Institut D'investigacio Biomedica de 
      Bellvitge), Universitat de Barcelona, Barcelona, Spain; REIPI (Spanish Network 
      for the Research in Infectious Diseases), Instituto de Salud Carlos III, Madrid, 
      Spain.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Observational Study
DEP - 20170306
PL  - England
TA  - Clin Microbiol Infect
JT  - Clinical microbiology and infection : the official publication of the European 
      Society of Clinical Microbiology and Infectious Diseases
JID - 9516420
RN  - 0 (Anti-Bacterial Agents)
RN  - 6GNT3Y5LMF (Levofloxacin)
RN  - 83905-01-5 (Azithromycin)
SB  - IM
MH  - Aged
MH  - Anti-Bacterial Agents/administration & dosage/*therapeutic use
MH  - Azithromycin/administration & dosage/*therapeutic use
MH  - Female
MH  - Humans
MH  - Legionnaires' Disease/*drug therapy/*epidemiology
MH  - Length of Stay/statistics & numerical data
MH  - Levofloxacin/administration & dosage/*therapeutic use
MH  - Male
MH  - Middle Aged
MH  - Propensity Score
MH  - Retrospective Studies
MH  - Spain/epidemiology
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Azithromycin
OT  - Clarithromycin
OT  - Legionellosis
OT  - Levofloxacin
OT  - Outcomes
EDAT- 2017/03/08 06:00
MHDA- 2018/04/21 06:00
CRDT- 2017/03/08 06:00
PHST- 2016/10/10 00:00 [received]
PHST- 2017/02/21 00:00 [revised]
PHST- 2017/02/25 00:00 [accepted]
PHST- 2017/03/08 06:00 [pubmed]
PHST- 2018/04/21 06:00 [medline]
PHST- 2017/03/08 06:00 [entrez]
AID - S1198-743X(17)30127-1 [pii]
AID - 10.1016/j.cmi.2017.02.030 [doi]
PST - ppublish
SO  - Clin Microbiol Infect. 2017 Sep;23(9):653-658. doi: 10.1016/j.cmi.2017.02.030. 
      Epub 2017 Mar 6.