Impact of macrolide therapy in patients hospitalized with Pseudomonas aeruginosa community-acquired pneumonia.
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 &gt; 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 immunomodulators in patients with P aeruginosa CAP.
Hospital Comarcal de Mollet, Mollet del Vallès, Spain; University of Texas Health Science Center at San Antonio, San Antonio, TX.
Elena
E
Laserna
University of Texas Health Science Center at San Antonio, San Antonio, TX; Servei de Pneumologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Institut d'Investigació Biomedica Sant Pau, Barcelona, Spain.
Oriol
O
Sibila
University of Texas Health Science Center at San Antonio, San Antonio, TX; South Texas Veterans Health Care System, San Antonio, TX.
Juan Felipe
JF
Fernandez
University of Texas Health Science Center at San Antonio, San Antonio, TX; South Texas Veterans Health Care System, San Antonio, TX.
Diego Jose
DJ
Maselli
North Texas Veterans Health Care System, Dallas, TX; University of Texas Southwestern Medical Center, Dallas, TX.
Eric M
EM
Mortensen
University of Texas Health Science Center at San Antonio, San Antonio, TX; South Texas Veterans Health Care System, San Antonio, TX.
Antonio
A
Anzueto
University of Western Australia, Perth, WA, Australia; Feinberg School of Medicine, Northwestern University, Chicago, IL.
Grant
G
Waterer
University of Texas Health Science Center at San Antonio, San Antonio, TX; South Texas Veterans Health Care System, San Antonio, TX. Electronic address: restrepom@uthscsa.edu.
Marcos I
MI
Restrepo
D000368:Aged; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006787:Hospitals, Veterans; D006801:Humans; D007297:Inpatients; D007902:Length of Stay / Q000639:trends; D018942:Macrolides / Q000627:therapeutic use*; D008297:Male; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D011552:Pseudomonas Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
D018942:Macrolides