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

Research output: Contribution to journalArticle

2 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)115-121
Number of pages7
JournalRespiratory Medicine
Volume140
DOIs
Publication statusPublished - Jul 2018

Fingerprint

Macrolides
Pneumonia
Bacteremia
Mortality
Therapeutics
Length of Stay
Confidence Intervals
Hospital Mortality
Streptococcus pneumoniae
Organizations
Databases

Keywords

  • Antimicrobial treatment
  • Bacteremia
  • Community-acquired pneumonia
  • Mortality

Cite this

@article{ed7a2a35c1c441af9ebd9383be1c1730,
title = "Macrolide therapy is associated with lower mortality in community-acquired bacteraemic pneumonia",
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.",
keywords = "Antimicrobial treatment, Bacteremia, Community-acquired pneumonia, Mortality",
author = "Arnold, {Forest W.} and Gustavo Lopardo and Wiemken, {Timothy L.} and Robert Kelley and Paula Peyrani and Mattingly, {William A.} and Charles Feldman and Martin Gnoni and Rosemeri Maurici and Ramirez, {Julio A.} and Forest Arnold and Paula Peyrani and Julio Ramirez and Kwabena Ayesu and Thomas File and Steven Burdette and Stephen Blatt and Marcos Restrepo and Jose Bordon and Peter Gross and Daniel Musher and Thomas Marrie and Karl Weiss and Jorge Roig and Harmut Lode and Tobias Welte and Stephano Aliberti and Francesco Blasi and Roberto Cosentini and Delfino Legnani and Fabio Franzetti and Nicola Montano and Giulia Cervi and Paolo Rossi and Antonio Voza and Belinda Ostrowsky and Alberto Pesci and Stefano Nava and Pierluigi Viale and Vanni Galavatti and Aruj Patricia and Carlos Dimas and Roberto Piro and Claudio Viscoli and Antoni Torres and Vincenzo Valenti and Ojales, {Daniel Portela} and Maria Bodi and James Chalmers and Tom Fardon",
year = "2018",
month = "7",
doi = "10.1016/j.rmed.2018.05.020",
language = "English",
volume = "140",
pages = "115--121",
journal = "Respiratory Medicine",
issn = "0954-6111",
publisher = "Elsevier",

}

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

In: Respiratory Medicine, Vol. 140, 07.2018, p. 115-121.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Macrolide therapy is associated with lower mortality in community-acquired bacteraemic pneumonia

AU - Arnold, Forest W.

AU - Lopardo, Gustavo

AU - Wiemken, Timothy L.

AU - Kelley, Robert

AU - Peyrani, Paula

AU - Mattingly, William A.

AU - Feldman, Charles

AU - Gnoni, Martin

AU - Maurici, Rosemeri

AU - Ramirez, Julio A.

AU - Arnold, Forest

AU - Peyrani, Paula

AU - Ramirez, Julio

AU - Ayesu, Kwabena

AU - File, Thomas

AU - Burdette, Steven

AU - Blatt, Stephen

AU - Restrepo, Marcos

AU - Bordon, Jose

AU - Gross, Peter

AU - Musher, Daniel

AU - Marrie, Thomas

AU - Weiss, Karl

AU - Roig, Jorge

AU - Lode, Harmut

AU - Welte, Tobias

AU - Aliberti, Stephano

AU - Blasi, Francesco

AU - Cosentini, Roberto

AU - Legnani, Delfino

AU - Franzetti, Fabio

AU - Montano, Nicola

AU - Cervi, Giulia

AU - Rossi, Paolo

AU - Voza, Antonio

AU - Ostrowsky, Belinda

AU - Pesci, Alberto

AU - Nava, Stefano

AU - Viale, Pierluigi

AU - Galavatti, Vanni

AU - Patricia, Aruj

AU - Dimas, Carlos

AU - Piro, Roberto

AU - Viscoli, Claudio

AU - Torres, Antoni

AU - Valenti, Vincenzo

AU - Ojales, Daniel Portela

AU - Bodi, Maria

AU - Chalmers, James

AU - Fardon, Tom

PY - 2018/7

Y1 - 2018/7

N2 - 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.

AB - 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.

KW - Antimicrobial treatment

KW - Bacteremia

KW - Community-acquired pneumonia

KW - Mortality

U2 - 10.1016/j.rmed.2018.05.020

DO - 10.1016/j.rmed.2018.05.020

M3 - Article

AN - SCOPUS:85048390451

VL - 140

SP - 115

EP - 121

JO - Respiratory Medicine

JF - Respiratory Medicine

SN - 0954-6111

ER -