Impact of Macrolide Therapy in Patients Hospitalized with Pseudomonas aeruginosa Community-Acquired Pneumonia.
Chest. 2014 Jan 23;
Authors: Laserna E, Sibila O, Fernandez JF, Maselli DJ, Mortensen EM, Anzueto A, Waterer G, Restrepo MI
ABSTRACT BACKGROUND: Several studies described a clinical benefit of macrolides due to their immunomodulatory properties in different respiratory diseases. We aim to assess the effect of macrolide therapy on mortality for patients hospitalized due to 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 healthcare-associated pneumonia and immunosuppression were excluded. Macrolide therapy was considered when administered in the first 48 hours 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. 171 patients (42.5%) received a macrolide during the first 48 hours of admission. These patients were older and white. Macrolide use was not associated with lower 30-day mortality (HR 1.14, 95% CI 0.70-1.83, p=0.5). In addition, macrolide treated patients had no differences in ICU admission, use of mechanical ventilation, use of vasopressors and length of stay (LOS), when compared to patients that did not receive macrolides. A subgroup analyses among ICU P. aeruginosa CAP patients showed no differences on baseline characteristics and outcomes.
CONCLUSIONS: Macrolide therapy in the first 48 hours of admission is not associated with decreased 30-day mortality, ICU admission, need for mechanical ventilation and LOS in P. aeruginosa CAP hospitalized patients. Further larger cohort studies research should address the benefit of macrolides as immunomodulators in patients with P. aeruginosa CAP.
PMID: 24458223 [PubMed - as supplied by publisher]