Elena Laserna1, Oriol Sibila2, Juan Felipe Fernandez3, Diego Jose Maselli3, Eric M Mortensen4, Antonio Anzueto3, Grant Waterer5, Marcos I Restrepo6. 1. Hospital Comarcal de Mollet, Mollet del Vallès, Spain; University of Texas Health Science Center at San Antonio, San Antonio, TX. 2. University of Texas Health Science Center at San Antonio, San Antonio, TX; Servei de Pneumologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Institut d'Investigació Biomedica Sant Pau, Barcelona, Spain. 3. University of Texas Health Science Center at San Antonio, San Antonio, TX; South Texas Veterans Health Care System, San Antonio, TX. 4. North Texas Veterans Health Care System, Dallas, TX; University of Texas Southwestern Medical Center, Dallas, TX. 5. University of Western Australia, Perth, WA, Australia; Feinberg School of Medicine, Northwestern University, Chicago, IL. 6. University of Texas Health Science Center at San Antonio, San Antonio, TX; South Texas Veterans Health Care System, San Antonio, TX. Electronic address: restrepom@uthscsa.edu.
Abstract
BACKGROUND: Several studies have described a clinical benefit of macrolides due to their immunomodulatory properties in various respiratory diseases. We aimed to assess the effect of macrolide therapy on mortality in patients hospitalized for Pseudomonas aeruginosa community-acquired pneumonia (CAP). METHODS: We performed a retrospective population-based study of > 150 hospitals in the US Veterans Health Administration. Patients were included if they had a diagnosis of CAP and P aeruginosa was identified as the causative pathogen. Patients with health-care-associated pneumonia and immunosuppression were excluded. Macrolide therapy was considered when administered within the first 48 h of admission. Univariate and multivariable analyses were performed using 30-day mortality as the dependent measure. RESULTS: We included 402 patients with P aeruginosa CAP, of whom 171 (42.5%) received a macrolide during the first 48 h of admission. These patients were older and white. Macrolide use was not associated with lower 30-day mortality (hazard ratio, 1.14; 95% CI, 0.70-1.83; P = .5). In addition, patients treated with macrolides had no differences in ICU admission, use of mechanical ventilation, use of vasopressors, and length of stay (LOS) compared with patients not treated with macrolides. A subgroup analysis among patients with P aeruginosa CAP in the ICU showed no differences in baseline characteristics and outcomes. CONCLUSIONS: Macrolide therapy in the first 48 h of admission is not associated with decreased 30-day mortality, ICU admission, need for mechanical ventilation, and LOS in hospitalized patients with P aeruginosa CAP. Larger cohort studies should address the benefit of macrolides as immunomodulators in patients with P aeruginosa CAP.
BACKGROUND: Several studies have described a clinical benefit of macrolides due to their immunomodulatory properties in various respiratory diseases. We aimed to assess the effect of macrolide therapy on mortality in patients hospitalized for Pseudomonas aeruginosa community-acquired pneumonia (CAP). METHODS: We performed a retrospective population-based study of > 150 hospitals in the US Veterans Health Administration. Patients were included if they had a diagnosis of CAP and P aeruginosa was identified as the causative pathogen. Patients with health-care-associated pneumonia and immunosuppression were excluded. Macrolide therapy was considered when administered within the first 48 h of admission. Univariate and multivariable analyses were performed using 30-day mortality as the dependent measure. RESULTS: We included 402 patients with P aeruginosa CAP, of whom 171 (42.5%) received a macrolide during the first 48 h of admission. These patients were older and white. Macrolide use was not associated with lower 30-day mortality (hazard ratio, 1.14; 95% CI, 0.70-1.83; P = .5). In addition, patients treated with macrolides had no differences in ICU admission, use of mechanical ventilation, use of vasopressors, and length of stay (LOS) compared with patients not treated with macrolides. A subgroup analysis among patients with P aeruginosa CAP in the ICU showed no differences in baseline characteristics and outcomes. CONCLUSIONS:Macrolide therapy in the first 48 h of admission is not associated with decreased 30-day mortality, ICU admission, need for mechanical ventilation, and LOS in hospitalized patients with P aeruginosa CAP. Larger cohort studies should address the benefit of macrolides as immunomodulators in patients with P aeruginosa CAP.
Authors: José A Martínez; Juan P Horcajada; Manuel Almela; Francesc Marco; Alex Soriano; Elisa García; Maria Angeles Marco; Antoni Torres; Josep Mensa Journal: Clin Infect Dis Date: 2003-01-31 Impact factor: 9.079
Authors: Lionel A Mandell; Richard G Wunderink; Antonio Anzueto; John G Bartlett; G Douglas Campbell; Nathan C Dean; Scott F Dowell; Thomas M File; Daniel M Musher; Michael S Niederman; Antonio Torres; Cynthia G Whitney Journal: Clin Infect Dis Date: 2007-03-01 Impact factor: 9.079
Authors: Francisco Arancibia; Torsten T Bauer; Santiago Ewig; Josep Mensa; Julia Gonzalez; Michael S Niederman; Antoni Torres Journal: Arch Intern Med Date: 2002-09-09