Macrolides in severe community-acquired pneumonia and sepsis

More than 750,000 cases of severe sepsis occur annually (Angus et al. 2001), making the incidence of severe sepsis higher than that of breast cancer, AIDS, or first myocardial infarction. The incidence of sepsis is increasing because of the aging population, the growing number of immunocompromised patients, and the increasing use of invasive procedures, and to a lesser extent, because of antibiotic resistance among pathogens. In the United States alone, almost $17 billion is spent each year treating patients with sepsis (Angus et al. 2001). Despite advances in care, more than 210,000 patients with severe sepsis die annually (Angus et al. 2001). The mortality rate associated with severe sepsis remains between 20% and 80% (Zeni et al. 1997). Even dysfunction of a single organ places patients at a significant risk for dying (about 20%), with mortality rates increasing approximately 15-20% for each additional dysfunctional organ (Vincent et al. 1998). Mortality rates are highest (ranging from 50 to 80%) for patients with cardiovascular compromise (septic shock) (Rangel-Frausto et al. 1995). Respiratory infections, whether community- or hospital-acquired account for the most sepsis cases (Angus et al. 2001; Bernard et al. 2001; Martin et al. 2003). Community-acquired pneumonia (CAP) is one the most common reasons for sepsis and is itself, independent of sepsis, the seventh leading cause of death and the leading cause of infectious death in the United States (Hoyert et al. 2005).