Impact of macrolide treatment on long-term mortality in patients admitted to the ICU due to CAP: a targeted maximum likelihood estimation and survival analysis

  • Luis Felipe Reyes (Creator)
  • Esteban Garcia (Creator)
  • Elsa D. Ibáñez-Prada (Creator)
  • Cristian C. Serrano-Mayorga (Creator)
  • Yuli V. Fuentes (Creator)
  • Alejandro H. Rodriguez (Creator)
  • Gerard Moreno (Creator)
  • Alirio Bastidas (Creator)
  • Josep Gomez (Creator)
  • Angélica Gonzalez (Creator)
  • Christopher R. Frei (Creator)
  • Leo Anthony Celi (Creator)
  • Ignacio Martín-Loeches (Creator)
  • Grant W. Waterer (Creator)



    Abstract Introduction Patients with community-acquired pneumonia (CAP) admitted to the intensive care unit (ICU) have high mortality rates during the acute infection and up to ten years thereafter. Recommendations from international CAP guidelines include macrolide-based treatment. However, there is no data on the long-term outcomes of this recommendation. Therefore, we aimed to determine the impact of macrolide-based therapy on long-term mortality in this population. Methods Registered patients in the MIMIC-IV database 16 years or older and admitted to the ICU due to CAP were included. Multivariate analysis, targeted maximum likelihood estimation (TMLE) to simulate a randomised controlled trial, and survival analyses were conducted to test the effect of macrolide-based treatment on mortality six-month (6 m) and twelve-month (12 m) after hospital admission. A sensitivity analysis was performed excluding patients with Pseudomonas aeruginosa or MRSA pneumonia to control for Healthcare-Associated Pneumonia (HCAP). Results 3775 patients were included, and 1154 were treated with a macrolide-based treatment. The non-macrolide-based group had worse long-term clinical outcomes, represented by 6 m [31.5 (363/1154) vs 39.5 (1035/2621), p 
    Date made available2023

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