Impact of Macrolide Therapy in Patients Hospitalized With Pseudomonas aeruginosa Community-Acquired Pneumonia
Por:
Laserna, E, Sibila, O, Fernandez, JF, Maselli, DJ, Mortensen, EM, Anzueto, A, Waterer, G, Restrepo, MI
Publicada:
1 may 2014
Resumen:
Background: Several studies have described a clinical benefit of macrolides due to their immunomodulatory properties in various respiratory diseases. We aimed to assess the effect of macrolide therapy on mortality in patients hospitalized for 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 health-care-associated pneumonia and immunosuppression were excluded. Macrolide therapy was considered when administered within the first 48 h 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, of whom 171 (42.5%) received a macrolide during the first 48 h of admission. These patients were older and white. Macrolide use was not associated with lower 30-day mortality (hazard ratio, 1.14; 95% CI, 0.70-1.83; P=.5). In addition, patients treated with macrolides had no differences in ICU admission, use of mechanical ventilation, use of vasopressors, and length of stay (LOS) compared with patients not treated with macrolides. A subgroup analysis among patients with P aeruginosa CAP in the ICU showed no differences in baseline characteristics and outcomes.
Conclusions: Macrolide therapy in the first 48 h of admission is not associated with decreased 30-day mortality, ICU admission, need for mechanical ventilation, and LOS in hospitalized patients with P aeruginosa CAP. Larger cohort studies should address the benefit of macrolides as immuno-modulators in patients with P aeruginosa CAP.
Filiaciones:
Laserna, E:
Hosp Comarcal de Mollet, Mollet Del Valles, Spain
Univ Texas Hlth Sci Ctr San Antonio, San Antonio, TX 78229 USA
Sibila, O:
Univ Texas Hlth Sci Ctr San Antonio, San Antonio, TX 78229 USA
Hosp Santa Creu & Sant Pau, Serv Pneumol, Barcelona, Spain
Inst Invest Biomed St Pau, Barcelona, Spain
Fernandez, JF:
Univ Texas Hlth Sci Ctr San Antonio, San Antonio, TX 78229 USA
South Texas Vet Hlth Care Syst, San Antonio, TX 78229 USA
Maselli, DJ:
Univ Texas Hlth Sci Ctr San Antonio, San Antonio, TX 78229 USA
South Texas Vet Hlth Care Syst, San Antonio, TX 78229 USA
Mortensen, EM:
North Texas Vet Hlth Care Syst, Dallas, TX USA
Univ Texas SW Med Ctr Dallas, Dallas, TX 75390 USA
Anzueto, A:
Univ Texas Hlth Sci Ctr San Antonio, San Antonio, TX 78229 USA
South Texas Vet Hlth Care Syst, San Antonio, TX 78229 USA
Waterer, G:
Univ Western Australia, Perth, WA 6009, Australia
Northwestern Univ, Feinberg Sch Med, Chicago, IL 60611 USA
Restrepo, MI:
Univ Texas Hlth Sci Ctr San Antonio, San Antonio, TX 78229 USA
South Texas Vet Hlth Care Syst, San Antonio, TX 78229 USA
Green Published
|