1. Macrolide therapy is associated with lower mortality in community-acquired bacteraemic pneumonia
- Author
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Forest W. Arnold, Gustavo Lopardo, Timothy L. Wiemken, Robert Kelley, Paula Peyrani, William A. Mattingly, Charles Feldman, Martin Gnoni, Rosemeri Maurici, Julio A. Ramirez, Forest Arnold, Julio Ramirez, Kwabena Ayesu, Thomas File, Steven Burdette, Stephen Blatt, Marcos Restrepo, Jose Bordon, Peter Gross, Daniel Musher, Thomas Marrie, Karl Weiss, Jorge Roig, Harmut Lode, Tobias Welte, Stephano Aliberti, Francesco Blasi, Roberto Cosentini, Delfino Legnani, Fabio Franzetti, Nicola Montano, Giulia Cervi, Paolo Rossi, Antonio Voza, Belinda Ostrowsky, Alberto Pesci, Stefano Nava, Pierluigi Viale, Vanni Galavatti, Aruj Patricia, Carlos Dimas, Roberto Piro, Claudio Viscoli, Antoni Torres, Vincenzo Valenti, Daniel Portela Ojales, Maria Bodi, Jose Porras, Jordi Rello, Rosario Menendez, Daiana Stolz, Philipp Schuetz, Sebastian Haubitz, James Chalmers, Tom Fardon, Guillermo Benchetrit, Eduardo Rodriguez, Jorge Corral, Jose Gonzalez, Lautaro de Vedia, Carlos Luna, Jorge Martinez, Lucia Marzoratti, Maria Rodriguez, Alejandro Videla, Federico Saavedra, Horacio Lopez, Carlos Victorio, Fernando Riera, Patricio Jimenez, Patricia Fernandez, Maria Parada, Alejandro Díaz Fuenzalida, Raul Riquelme, Manuel Barros, Juan Manuel Luna, Ivan Toala, Guillermo Arbo Oze de Morvil, Ricardo Fernandez, Gonzalo Aiello, Pablo Alvarez, Ana Soca, Federico Arteta, Jose Delgado, Gur Levy, Ludwig Rivero, Benito Rodriguez, Mario Perez Mirabal, Marilyn Mateo, Myrna Mendoza, Arnold, F, Lopardo, G, Wiemken, T, Kelley, R, Peyrani, P, Mattingly, W, Feldman, C, Gnoni, M, Maurici, R, Ramirez, J, Ayesu, K, File, T, Burdette, S, Blatt, S, Restrepo, M, Bordon, J, Gross, P, Musher, D, Marrie, T, Weiss, K, Roig, J, Lode, H, Welte, T, Aliberti, S, Blasi, F, Cosentini, R, Legnani, D, Franzetti, F, Montano, N, Cervi, G, Rossi, P, Voza, A, Ostrowsky, B, Pesci, A, Nava, S, Viale, P, Galavatti, V, Patricia, A, Dimas, C, Piro, R, Viscoli, C, Torres, A, Valenti, V, Ojales, D, Bodi, M, Porras, J, Rello, J, Menendez, R, Stolz, D, Schuetz, P, Haubitz, S, Chalmers, J, Fardon, T, Benchetrit, G, Rodriguez, E, Corral, J, Gonzalez, J, de Vedia, L, Luna, C, Martinez, J, Marzoratti, L, Rodriguez, M, Videla, A, Saavedra, F, Lopez, H, Victorio, C, Riera, F, Jimenez, P, Fernandez, P, Parada, M, Fuenzalida, A, Riquelme, R, Barros, M, Luna, J, Toala, I, Oze de Morvil, G, Fernandez, R, Aiello, G, Alvarez, P, Soca, A, Arteta, F, Delgado, J, Levy, G, Rivero, L, Rodriguez, B, Mirabal, M, Mateo, M, and Mendoza, M
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Adult ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Databases, Factual ,Community-acquired pneumonia ,Antimicrobial treatment ,Bacteremia ,Kaplan-Meier Estimate ,medicine.disease_cause ,Severity of Illness Index ,03 medical and health sciences ,symbols.namesake ,0302 clinical medicine ,Internal medicine ,Streptococcus pneumoniae ,medicine ,Pneumonia, Bacterial ,Humans ,030212 general & internal medicine ,Poisson regression ,Hospital Mortality ,Mortality ,Aged ,Aged, 80 and over ,business.industry ,Length of Stay ,Middle Aged ,medicine.disease ,Confidence interval ,Anti-Bacterial Agents ,Community-Acquired Infections ,Pneumonia ,Regimen ,Treatment Outcome ,030228 respiratory system ,Relative risk ,symbols ,Drug Therapy, Combination ,Female ,Macrolides ,business - 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.
- Published
- 2018