Impact of macrolide therapy in patients hospitalized with pseudomonas aeruginosa community-acquired pneumonia

Elena Laserna, Oriol Sibila, Juan Felipe Fernandez, Diego Jose Maselli, Eric M. Mortensen, Antonio R Anzueto, Grant Waterer, Marcos Restrepo

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background: Several studies have described a clinical benefi t 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 identifi ed as the causative pathogen. Patients with health-care-associated pneumonia and immunosuppression were excluded. Macrolide therapy was considered when administered within the fi rst 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 fi rst 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 .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 fi rst 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 benefi t of macrolides as immunomodulators in patients with P aeruginosa CAP.

Original languageEnglish (US)
Pages (from-to)1114-1120
Number of pages7
JournalChest
Volume145
Issue number5
DOIs
StatePublished - 2014

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Macrolides
Pseudomonas aeruginosa
Pneumonia
Therapeutics
Mortality
Artificial Respiration
Length of Stay
Veterans Health
United States Department of Veterans Affairs
Immunologic Factors
Immunosuppression
Cohort Studies
Delivery of Health Care

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Impact of macrolide therapy in patients hospitalized with pseudomonas aeruginosa community-acquired pneumonia. / Laserna, Elena; Sibila, Oriol; Fernandez, Juan Felipe; Maselli, Diego Jose; Mortensen, Eric M.; Anzueto, Antonio R; Waterer, Grant; Restrepo, Marcos.

In: Chest, Vol. 145, No. 5, 2014, p. 1114-1120.

Research output: Contribution to journalArticle

Laserna, E, Sibila, O, Fernandez, JF, Maselli, DJ, Mortensen, EM, Anzueto, AR, Waterer, G & Restrepo, M 2014, 'Impact of macrolide therapy in patients hospitalized with pseudomonas aeruginosa community-acquired pneumonia', Chest, vol. 145, no. 5, pp. 1114-1120. https://doi.org/10.1378/chest.13-1607
Laserna, Elena ; Sibila, Oriol ; Fernandez, Juan Felipe ; Maselli, Diego Jose ; Mortensen, Eric M. ; Anzueto, Antonio R ; Waterer, Grant ; Restrepo, Marcos. / Impact of macrolide therapy in patients hospitalized with pseudomonas aeruginosa community-acquired pneumonia. In: Chest. 2014 ; Vol. 145, No. 5. pp. 1114-1120.
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abstract = "Background: Several studies have described a clinical benefi t 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 identifi ed as the causative pathogen. Patients with health-care-associated pneumonia and immunosuppression were excluded. Macrolide therapy was considered when administered within the fi rst 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 fi rst 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 .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 fi rst 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 benefi t of macrolides as immunomodulators in patients with P aeruginosa CAP.",
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T1 - Impact of macrolide therapy in patients hospitalized with pseudomonas aeruginosa community-acquired pneumonia

AU - Laserna, Elena

AU - Sibila, Oriol

AU - Fernandez, Juan Felipe

AU - Maselli, Diego Jose

AU - Mortensen, Eric M.

AU - Anzueto, Antonio R

AU - Waterer, Grant

AU - Restrepo, Marcos

PY - 2014

Y1 - 2014

N2 - Background: Several studies have described a clinical benefi t 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 identifi ed as the causative pathogen. Patients with health-care-associated pneumonia and immunosuppression were excluded. Macrolide therapy was considered when administered within the fi rst 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 fi rst 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 .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 fi rst 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 benefi t of macrolides as immunomodulators in patients with P aeruginosa CAP.

AB - Background: Several studies have described a clinical benefi t 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 identifi ed as the causative pathogen. Patients with health-care-associated pneumonia and immunosuppression were excluded. Macrolide therapy was considered when administered within the fi rst 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 fi rst 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 .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 fi rst 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 benefi t of macrolides as immunomodulators in patients with P aeruginosa CAP.

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U2 - 10.1378/chest.13-1607

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