Forest W Arnold1, Jose Bordon2, Rafael Fernandez-Botran3, Madhavi J Rane4, Silvia M Uriarte4, Robert Kelley5, Timothy L Wiemken5, Paula Peyrani5, Julio A Ramirez5. 1. Division of Infectious Diseases, Department of Medicine, University of Louisville School of Medicine, 501 E. Broadway; Suite 140 B, Louisville, KY, 40202, USA. f.arnold@louisville.edu. 2. Section of Infectious Diseases, Providence Hospital, Washington, DC, USA. 3. Department of Pathology and Laboratory Medicine, University of Louisville School of Medicine, Louisville, KY, USA. 4. Division of Nephrology and Hypertension, Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA. 5. Division of Infectious Diseases, Department of Medicine, University of Louisville School of Medicine, 501 E. Broadway; Suite 140 B, Louisville, KY, 40202, USA.
Abstract
PURPOSE: The objective of this study was to measure plasma cytokine levels and blood neutrophil functions as well as clinical outcomes in hospitalized patients with community-acquired pneumonia (CAP) treated with or without macrolide use--a known modulator of inflammatory response. METHODS: Subjects with CAP had peripheral blood analyzed for some neutrophil functions (degranulation of secretory vesicles and specific granules, respiratory burst response and phagocytosis) and ten cytokine levels measured in serum and sputum supernatants. Neutrophil function in healthy volunteers was also measured for reference. Values were measured on the day of enrollment, days 2-4 and 5-7, depending on a patient's length of stay. Early and late clinical outcomes were also evaluated. All values were compared between those treated with or without a macrolide. RESULTS: A total of 40 subjects were in this study; 14 received macrolide treatment, and 26 did not. Neutrophil function in the macrolide group was not significantly different compared to the non-macrolide group. None of the median cytokine levels or IQRs were statistically significant between the groups. However, a trend toward decreased IL-6, IL-8, and IFN-γ levels, and favorable clinical outcomes were present in the macrolide group. CONCLUSIONS: This pilot study showed no statistical difference between cytokine levels or neutrophil activity for CAP patients prescribed a macrolide containing regimen. Considering the trend of lower cytokine levels in the macrolide group when comparing the 5- to 7-day time period with the non-macrolide group, a full study with an appropriate sample size may be warranted.
PURPOSE: The objective of this study was to measure plasma cytokine levels and blood neutrophil functions as well as clinical outcomes in hospitalized patients with community-acquired pneumonia (CAP) treated with or without macrolide use--a known modulator of inflammatory response. METHODS: Subjects with CAP had peripheral blood analyzed for some neutrophil functions (degranulation of secretory vesicles and specific granules, respiratory burst response and phagocytosis) and ten cytokine levels measured in serum and sputum supernatants. Neutrophil function in healthy volunteers was also measured for reference. Values were measured on the day of enrollment, days 2-4 and 5-7, depending on a patient's length of stay. Early and late clinical outcomes were also evaluated. All values were compared between those treated with or without a macrolide. RESULTS: A total of 40 subjects were in this study; 14 received macrolide treatment, and 26 did not. Neutrophil function in the macrolide group was not significantly different compared to the non-macrolide group. None of the median cytokine levels or IQRs were statistically significant between the groups. However, a trend toward decreased IL-6, IL-8, and IFN-γ levels, and favorable clinical outcomes were present in the macrolide group. CONCLUSIONS: This pilot study showed no statistical difference between cytokine levels or neutrophil activity for CAPpatients prescribed a macrolide containing regimen. Considering the trend of lower cytokine levels in the macrolide group when comparing the 5- to 7-day time period with the non-macrolide group, a full study with an appropriate sample size may be warranted.
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Authors: Rafael Fernandez-Botran; Silvia M Uriarte; Forest W Arnold; Lisandra Rodriguez-Hernandez; Madhavi J Rane; Paula Peyrani; Timothy Wiemken; Robert Kelley; Srinivas Uppatla; Rodrigo Cavallazzi; Francesco Blasi; Letizia Morlacchi; Stefano Aliberti; Colleen Jonsson; Julio A Ramirez; Jose Bordon Journal: Inflammation Date: 2014-08 Impact factor: 4.092