title: Macrolides are associated with a better survival rate in patients hospitalized with community-acquired but not healthcare-associated pneumonia.
abstract: 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 [AOR] 0.67; 95% confidence interval [CI] 0.54-0.81; p=0.043). Separate propensity score analyses of patients with CAP (AOR 0.20; 95% CI 0.11-0.34; p=0.003) and HCAP (AOR 0.81; 95% CI 0.65-1.01; p=0.337) produced discordant findings.
  
  
  CONCLUSIONS
  Macrolide-based treatment was associated with better survival in patients hospitalized with pneumonia. The survival advantage appeared predominantly among patients with CAP.
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine , St. Louis, Missouri.
authors.forename: Colleen
authors.initials: C
authors.lastname: McEvoy
authors.forename: Scott T
authors.initials: ST
authors.lastname: Micek
authors.forename: Richard M
authors.initials: RM
authors.lastname: Reichley
authors.forename: Jason
authors.initials: J
authors.lastname: Kan
authors.forename: Alex
authors.initials: A
authors.lastname: Hoban
authors.forename: Justin
authors.initials: J
authors.lastname: Hoffmann
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Shorr
authors.forename: Marin H
authors.initials: MH
authors.lastname: Kollef
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000188:drug therapy*; D003428:Cross Infection / Q000188:drug therapy*; D005260:Female; D006801:Humans; D018942:Macrolides / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000188:drug therapy*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D018942:Macrolides