Macrolide therapy is associated with lower mortality in community-acquired bacteraemic pneumonia.

Autor: Arnold FW; Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Louisville, Louisville, KY, United States. Electronic address: f.arnold@louisville.edu., Lopardo G; Hospital Professor Bernardo Houssay, Buenos Aires, Argentina. Electronic address: glopardo@intramed.net., Wiemken TL; Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Louisville, Louisville, KY, United States. Electronic address: Tim.Wiemken@louisville.edu., Kelley R; Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Louisville, Louisville, KY, United States. Electronic address: rrkelley@smcm.edu., Peyrani P; Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Louisville, Louisville, KY, United States. Electronic address: P0peyr01@louisville.edu., Mattingly WA; Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Louisville, Louisville, KY, United States. Electronic address: Bill.Mattingly@louisville.edu., Feldman C; Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. Electronic address: Charles.Feldman@wits.ac.za., Gnoni M; Good Samaritan Hospital, Cincinnati, OH, United States. Electronic address: tincoinfectologo@gmail.com., Maurici R; University Hospital, Federal University of Santa Catarina, Santa Catarina, Brazil. Electronic address: Rosemaurici@gmail.com., Ramirez JA; Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Louisville, Louisville, KY, United States. Electronic address: Julio.Ramirez@louisville.edu.
Jazyk: angličtina
Zdroj: Respiratory medicine [Respir Med] 2018 Jul; Vol. 140, pp. 115-121. Date of Electronic Publication: 2018 Jun 05.
DOI: 10.1016/j.rmed.2018.05.020
Abstrakt: 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.
(Copyright © 2018. Published by Elsevier Ltd.)
Databáze: MEDLINE
Externí odkaz: