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

Identificador:  imarina:3992829

Handle: https://hdl.handle.net/20.500.11797/imarina3992829

Autors:  Arnold, Forest W; Wiemken, Timothy L; Kelley, Robert; Peyrani, Paula; Mattingly, William A; Feldman, Charles; Maurici, Rosemeri; Ramirez, Julio A; Arnold, Forest; Ramirez, Julio; Ayesu, Kwabena; File, Thomas, Jr; Burdette, Steven; Blatt, Stephen; Restrepo, Marcos; Bordon, Jose; Gross, Peter; Musher, Daniel; Marrie, Thomas; Weiss, Karl; Roig, Jorge; Lode, Harmut; Welte, Tobias; Aliberti, Stephano; Blasi, Francesco; Cosentini, Roberto; Legnani, Delfino; Franzetti, Fabio; Montano, Nicola; Cervi, Giulia; Rossi, Paolo; Voza, Antonio; Ostrowsky, Belinda; Pesci, Alberto; Nava, Stefano; Viale, Pierluigi; Galavatti, Vanni; Patricia, Aruj; Dimas, Carlos; Piro, Roberto; Viscoli, Claudio; Torres, Antoni; Valenti, Vincenzo; Portela Ojales, Daniel; Bodi, Maria; Porras, Jose; Rello, Jordi; Menendez, Rosario; Stolz, Daiana; Schuetz, Philipp; Haubitz, Sebastian; Chalmers, James; Fardon, Tom; Benchetrit, Guillermo; Rodriguez, Eduardo; Corral, Jorge; Gonzalez, Jose; de Vedia, Lautaro; Lopardo, Gustavo; Luna, Carlos; Martinez, Jorge; Marzoratti, Lucia; Rodriguez, Maria; Videla, Alejandro; Saavedra, Federico; Lopez, Horacio; Gnoni, Martin; Victorio, Carlos; Riera, Fernando; Jimenez, Patricio; Fernandez, Patricia; Parada, Maria; Diaz Fuenzalida, Alejandro; Riquelme, Raul; Barros, Manuel; Manuel Luna, Juan; Toala, Ivan; Arbo Oze de Morvil, Guillermo; Fernandez, Ricardo; Aiello, Gonzalo; Alvarez, Pablo; Soca, Ana; Arteta, Federico; Delgado, Jose; Levy, Gur; Rivero, Ludwig; Rodriguez, Benito; Perez Mirabal, Mario; Mateo, Marilyn; Mendoza, Myrna

Resum:
© 2018 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.