Macrolide therapy is associated with lower mortality in community-acquired bacteraemic pneumonia. (July 2018)

• Record Type: Journal Article
• Authors: Arnold, Forest; Peyrani, Paula; Ramirez, Julio; Ayesu, Kwabena; File, Thomas; Burdette, Steven; Blatt, Stephen; Restrepo, Marcos; Bordon, Jose; Gross, Peter; Musher, Daniel; Marrie, Thomas; Weiss, Karl; Roig, Jorge; Lode, Harmut; Welte, Tobias; Aliberti, Stephano; Blasi, Francesco; Cosentini, Roberto; Legnani, Delfino; Franzetti, Fabio; Montano, Nicola; Cervi, Giulia; Rossi, Paolo; Voza, Antonio; Ostrowsky, Belinda; Pesci, Alberto; Nava, Stefano; Viale, Pierluigi; Galavatti, Vanni; Patricia, Aruj; Dimas, Carlos; Piro, Roberto; Viscoli, Claudio; Torres, Antoni; Valenti, Vincenzo; Ojales, Daniel Portela; Bodi, Maria; Porras, Jose; Rello, Jordi; Menendez, Rosario; Stolz, Daiana; Schuetz, Philipp; Haubitz, Sebastian; Chalmers, James; Fardon, Tom; Benchetrit, Guillermo; Rodriguez, Eduardo; Corral, Jorge; Gonzalez, Jose; de Vedia, Lautaro; Lopardo, Gustavo; Luna, Carlos; Martinez, Jorge; Marzoratti, Lucia; Rodriguez, Maria; Videla, Alejandro; Saavedra, Federico; Lopez, Horacio; Gnoni, Martin; Gonzalez, Jose; Victorio, Carlos; Riera, Fernando; Jimenez, Patricio; Fernandez, Patricia; Parada, Maria; Fuenzalida, Alejandro Díaz; Riquelme, Raul; Barros, Manuel; Luna, Juan Manuel; Toala, Ivan; Oze de Morvil, Guillermo Arbo; Fernandez, Ricardo; Aiello, Gonzalo; Alvarez, Pablo; Soca, Ana; Arteta, Federico; Delgado, Jose; Levy, Gur; Rivero, Ludwig; Rodriguez, Benito; Mirabal, Mario Perez; Mateo, Marilyn; Mendoza, Myrna; Feldman, Charles; Arnold, Forest W.; Lopardo, Gustavo; Wiemken, Timothy L.; Kelley, Robert; Peyrani, Paula; Mattingly, William A.; Feldman, Charles; Gnoni, Martin; Maurici, Rosemeri; Ramirez, Julio A.;
• Is Part Of: Respiratory medicine. Volume 140(2018)
• Page Start: 115
• Page End: 121
• Publication Date: 2018-07
• Subjects: Community-acquired pneumonia -- Mortality -- Bacteremia -- Antimicrobial treatment; CAP community-acquired pneumonia -- CAPO Community-Acquired Pneumonia Organization -- CI confidence interval -- HIV human immunodeficiency virus -- IQR interquartile ratio -- OR odds ratio -- PSI pneumonia severity index -- RCT randomized control trial -- RR relative risk -- SD standard deviation; Chest -- Diseases -- Periodicals; Chest -- Diseases -- Great Britain -- Periodicals; Respiratory organs -- Diseases -- Periodicals; Respiratory Tract Diseases -- Periodicals; Appareil respiratoire -- Maladies -- Périodiques; Thorax -- Maladies -- Périodiques; Appareil respiratoire -- Maladies -- Traitement -- Périodiques; Electronic journals; 616.2
• DOI: 10.1016/j.rmed.2018.05.020
• Languages: English
• ISSNs: 0954-6111

Abstract

Abstract: Background: Community-acquired pneumonia (CAP) has a potential complication of bacteremia. The objective of this study was to define the clinical outcomes of patients with CAP and bacteremia treated with and without a macrolide. Materials and methods: Secondary analysis of the Community-Acquired Pneumonia Organization database of hospitalized patients with CAP. Patients with a positive blood culture were categorized based on the presence or absence of a macrolide in their initial antimicrobial regimen, and severity of their CAP. Outcomes included in-hospital all-cause mortality, 30-day mortality, length of stay, and time to clinical stability. Results: Among 549 patients with CAP and bacteremia, 247 (45%) were treated with a macrolide and 302 (55%) were not. The primary pathogen was Streptococcus pneumoniae (74%). Poisson regression with robust error variance models were used to compare the adjusted effects of each study group on the outcomes. The unadjusted 30-day mortality was 18.4% in the macrolide group, and 29.6% in the non-macrolide group (adjusted relative risk (aRR)0.81; 95% confidence interval (CI)0.50–1.33; P = 0.41). Unadjusted in-hospital all-cause mortality was 7.3% in the macrolide group, and 18.9% in the non-macrolide group (aRR 0.54, 95% CI 0.30–0.98; P = 0.043). Length of stay and time to clinical stability were not significantly different. Conclusions: In-hospital mortality, but not 30-day mortality, was significantly better in the macrolide group. Our data support the use of a macrolide in hospitalized patients with CAP and bacteraemia. Graphical abstract: Highlights: Patients with community-acquired pneumonia and bacteremia have a high mortality. Mortality was significantly lower among patients who received a macrolide. The association was more significant among patients with severe pneumonia.