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Inpatient care of community-acquired pneumonia: DISCUSSION (4)

The association that we observed between certain antibiotic combinations and mortality may relate to effects of the antimicrobials themselves (inferior antibacterial effect or increased toxicity) or the presence of an unknown confounder, a particular problem in any study that is nonrandomized. Given the higher illness severity, as measured by the PSI, in patients receiving the ‘high risk’ antibiotic combinations, it is likely that other confounding factors are the cause. In the case of treatment with antianaerobe agents, the clinical suspicion of aspiration pneumonia is likely a powerful risk factor for mortality in CAP and should be considered in CAP mortality risk stratification. buy asthma inhalers
An analogous clinical impression of increased illness severity, above and beyond that captured by the PSI, may have been present in patients treated with the combination of cephalosporin and a macrolide, which may explain the increased mortality in this group. Similarly, we suspect that the association between macrolide monotherapy and shorter LOS could be due to an unmeasured confounder. The nonrandomized nature of this study is an important limitation in this regard, making it impossible to rule out the presence of important confounders.