Repositori URV

Identifier: imarina:3992829

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

Authors:
Arnold, Forest WLopardo, GustavoWiemken, Timothy LKelley, RobertPeyrani, PaulaMattingly, William AFeldman, CharlesGnoni, MartinMaurici, RosemeriRamirez, Julio AArnold, ForestRamirez, JulioAyesu, KwabenaFile, Thomas, JrBurdette, StevenBlatt, StephenRestrepo, MarcosBordon, JoseGross, PeterMusher, DanielMarrie, ThomasWeiss, KarlRoig, JorgeLode, HarmutWelte, TobiasAliberti, StephanoBlasi, FrancescoCosentini, RobertoLegnani, DelfinoFranzetti, FabioMontano, NicolaCervi, GiuliaRossi, PaoloVoza, AntonioOstrowsky, BelindaPesci, AlbertoNava, StefanoViale, PierluigiGalavatti, VanniPatricia, ArujDimas, CarlosPiro, RobertoViscoli, ClaudioTorres, AntoniValenti, VincenzoPortela Ojales, DanielBodi, MariaPorras, JoseRello, JordiMenendez, RosarioStolz, DaianaSchuetz, PhilippHaubitz, SebastianChalmers, JamesFardon, TomBenchetrit, GuillermoRodriguez, EduardoCorral, Jorgede Vedia, LautaroLuna, CarlosMartinez, JorgeMarzoratti, LuciaRodriguez, MariaVidela, AlejandroSaavedra, FedericoLopez, HoracioGonzalez, JoseVictorio, CarlosRiera, FernandoJimenez, PatricioFernandez, PatriciaParada, MariaDiaz Fuenzalida, AlejandroRiquelme, RaulBarros, ManuelManuel Luna, JuanToala, IvanArbo Oze de Morvil, GuillermoFernandez, RicardoAiello, GonzaloAlvarez, PabloSoca, AnaArteta, FedericoDelgado, JoseLevy, GurRivero, LudwigRodriguez, BenitoPerez Mirabal, MarioMateo, MarilynMendoza, Myrna

Abstract:
© 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.