Macrolides Are Associated with a Better Survival Rate in Patients Hospitalized with Community-Acquired But Not Healthcare-Associated Pneumonia

Abstract

"Macrolides are associated with a better survival rate in patients hospitalized with community-acquired but not healthcareassociated pneumonia. " Surgical Infections.15,3. 283-289. (2014 Background: Macrolide-based treatment has been associated with survival benefit in patients hospitalized with community-acquired pneumonia (CAP). However, the influence of macrolide therapy in all patients hospitalized with pneumonia, including healthcare-associated pneumonia (HCAP), is unclear.Methods: Analysis of a retrospective single-center cohort.Results: Community-acquired pneumonia was present in 220 (22.5%) of all patients with pneumonia admitted through the emergency department of Barnes-Jewish Hospital, and HCAP was present in 757. Macrolide-based treatment was administered to 411 patients (42.1%). These patients were more likely to have CAP than were patients not receiving macrolide-based therapy (35.3% vs. 13.3%; p < 0.001) and had lower scores on the CURB-65 tool, a measure of the severity of illness (2.4 -1.5 vs. 3.1 -1.3; p < 0.001). Patients receiving macrolides also had a lower hospital mortality rate in univariable analysis (12.7% vs. 27.2%; p < 0.001). A propensity score analysis showed that macrolide-based treatment was associated with a lower in-hospital mortality rate (adjusted odds ratio [

Mortality in patients with community‐onset pneumonia at low risk of drug‐resistant pathogens: Impact of β‐lactam plus macrolide combination therapy

“…This result suggests that macrolide effects other than appropriateness of antibiotics might affect mortality . Second, although BLM efficacy was questionable in patients with HCAP, our results suggest that BLM may be effective in patients at low risk for CAP‐DRPs in HCAP as well as those in CAP. This is additional evidence in favour of unified antibiotic selection in both CAP and HCAP.…”

Update on the combination effect of macrolide antibiotics in community-acquired pneumonia

“…Despite this, beneficial effects have been observed in clinical practice with their use, including earlier resolution of VAP, earlier extubation, and a reduced risk of death from sepsis and multiple organ dysfunction [29,30]. An RCT of macrolide therapy conducted in gram-negative sepsis due to extrapulmonary infection failed to meet its primary endpoint of reduced mortality [31].…”

The role of azithromycin in healthcare-associated pneumonia treatment

“…Because patients with CAP and HCAP can have overlapping exposures in the community, some have advocated for the use of macrolides or fluoroquinolones as part of the empiric regimen for patients with HCAP . In one single‐centred experience, 65% of patients with HCAP were treated with a macrolide despite no available guideline recommendation to support this practice . This is owing to the potential for atypical pathogens and the consequences of inadequate coverage of these microbes .…”

“…One recent meta‐analysis (23 studies, n = 137,574) indicated no benefit of macrolide therapy with regard to 30‐day mortality when only randomized controlled trials were evaluated (4·6% vs. 4·1% non‐users, P = 0·66) or guideline‐recommended therapy was provided (5·3% vs. 5·8% non‐users, P = 0·22) . The potential benefit of macrolides in reducing in‐hospital mortality for patients with CAP has not been consistently demonstrated, and based on the limited evidence, there does not appear to be a benefit in patients with HCAP …”

“…11 This is owing to the potential for atypical pathogens and the consequences of inadequate coverage of these microbes. 9,11 Further evidence supporting a role for macrolides comes from information regarding beneficial anti-inflammatory effects of these agents and data supporting a potential mortality benefit among patients in selected subgroups with CAP. 12 Balancing this potential in improved outcomes is the renewed appreciation regarding the cardiotoxicity of azithromycin.…”