Macrolides are associated with a better survival rate in patients hospitalized with community-acquired but not healthcare-associated pneumonia.

MedStar author(s):
Citation: Surgical Infections. 15(3):283-9, 2014 Jun.PMID: 24801126Institution: MedStar Washington Hospital CenterDepartment: Medicine/Pulmonary-Critical CareForm of publication: Journal ArticleMedline article type(s): Journal Article | Research Support, Non-U.S. Gov'tSubject headings: *Anti-Bacterial Agents/tu [Therapeutic Use] | *Community-Acquired Infections/dt [Drug Therapy] | *Cross Infection/dt [Drug Therapy] | *Macrolides/tu [Therapeutic Use] | *Pneumonia/dt [Drug Therapy] | Adolescent | Adult | Aged | Aged, 80 and over | Cohort Studies | Female | Humans | Male | Middle Aged | Retrospective Studies | Survival Rate | Treatment Outcome | Young AdultYear: 2014ISSN:
  • 1096-2964
Name of journal: Surgical infectionsAbstract: BACKGROUND: Macrolide-based treatment has been associated with survival benefit in patients hospitalized with community-acquired pneumonia (CAP). However, the influence of macrolide therapy in all patients hospitalized with pneumonia, including healthcare-associated pneumonia (HCAP), is unclear.CONCLUSIONS: Macrolide-based treatment was associated with better survival in patients hospitalized with pneumonia. The survival advantage appeared predominantly among patients with CAP.METHODS: Analysis of a retrospective single-center cohort.RESULTS: Community-acquired pneumonia was present in 220 (22.5%) of all patients with pneumonia admitted through the emergency department of Barnes-Jewish Hospital, and HCAP was present in 757. Macrolide-based treatment was administered to 411 patients (42.1%). These patients were more likely to have CAP than were patients not receiving macrolide-based therapy (35.3% vs. 13.3%; p<0.001) and had lower scores on the CURB-65 tool, a measure of the severity of illness (2.4+/-1.5 vs. 3.1+/-1.3; p<0.001). Patients receiving macrolides also had a lower hospital mortality rate in univariable analysis (12.7% vs. 27.2%; p<0.001). A propensity score analysis showed that macrolide-based treatment was associated with a lower in-hospital mortality rate (adjusted odds ratio [AOR] 0.67; 95% confidence interval [CI] 0.54-0.81; p=0.043). Separate propensity score analyses of patients with CAP (AOR 0.20; 95% CI 0.11-0.34; p=0.003) and HCAP (AOR 0.81; 95% CI 0.65-1.01; p=0.337) produced discordant findings.All authors: Hoban A, Hoffmann J, Kan J, Kollef MH, McEvoy C, Micek ST, Reichley RM, Shorr AFFiscal year: FY2014Digital Object Identifier: Date added to catalog: 2015-03-17
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Journal Article MedStar Authors Catalog Article 24801126 Available 24801126

BACKGROUND: Macrolide-based treatment has been associated with survival benefit in patients hospitalized with community-acquired pneumonia (CAP). However, the influence of macrolide therapy in all patients hospitalized with pneumonia, including healthcare-associated pneumonia (HCAP), is unclear.

CONCLUSIONS: Macrolide-based treatment was associated with better survival in patients hospitalized with pneumonia. The survival advantage appeared predominantly among patients with CAP.

METHODS: Analysis of a retrospective single-center cohort.

RESULTS: Community-acquired pneumonia was present in 220 (22.5%) of all patients with pneumonia admitted through the emergency department of Barnes-Jewish Hospital, and HCAP was present in 757. Macrolide-based treatment was administered to 411 patients (42.1%). These patients were more likely to have CAP than were patients not receiving macrolide-based therapy (35.3% vs. 13.3%; p<0.001) and had lower scores on the CURB-65 tool, a measure of the severity of illness (2.4+/-1.5 vs. 3.1+/-1.3; p<0.001). Patients receiving macrolides also had a lower hospital mortality rate in univariable analysis (12.7% vs. 27.2%; p<0.001). A propensity score analysis showed that macrolide-based treatment was associated with a lower in-hospital mortality rate (adjusted odds ratio [AOR] 0.67; 95% confidence interval [CI] 0.54-0.81; p=0.043). Separate propensity score analyses of patients with CAP (AOR 0.20; 95% CI 0.11-0.34; p=0.003) and HCAP (AOR 0.81; 95% CI 0.65-1.01; p=0.337) produced discordant findings.

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