title: Azithromycin use and outcomes in severe sepsis patients with and without pneumonia.
abstract: OBJECTIVE
  Studies investigating the association between macrolides and outcomes in both pulmonary and nonpulmonary critically ill patients are limited. We aimed to examine the association between azithromycin use and clinical outcomes in severe sepsis patients with and without pneumonia receiving mechanical ventilation.
  
  
  METHODS
  A retrospective cohort of 105 patients admitted to an adult intensive care unit (ICU) with severe sepsis in an urban university hospital were included in the study. Multivariable linear regression was performed to assess the relationship between azithromycin use and the following outcomes: 28-day ICU-free days and 28-day ventilator-free days.
  
  
  RESULTS
  In univariate analysis, patients receiving azithromycin had nearly 6 more ICU-free days on average than did patients not receiving azithromycin (P = .005). The increased ICU-free days remained in multivariable analysis adjusting for age, sex, race, ICU type, and presence of shock (P = .005). In stratified analysis examining the association of azithromycin use in severe sepsis patients without pneumonia (n = 74), the results were similar to the full cohort.
  
  
  CONCLUSIONS
  Azithromycin was associated with more ICU-free days in severe sepsis patients with and without pneumonia. Further investigations are warranted to better elicit the association of macrolide use on clinical outcomes in severe sepsis patients, especially those without pneumonia.
authors.affiliation: Department of Medicine, Loyola University Chicago Health Sciences Campus, Maywood, IL; Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago Health Science Campus, Maywood, IL. Electronic address: majid.afshar@luhs.org.
authors.forename: Majid
authors.initials: M
authors.lastname: Afshar
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Colorado School of Medicine, Aurora, CO. Electronic address: clayton.foster@ucdenver.edu.
authors.forename: Clayton L
authors.initials: CL
authors.lastname: Foster
authors.affiliation: Department of Medicine, Loyola University Chicago Health Sciences Campus, Maywood, IL; Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago Health Science Campus, Maywood, IL. Electronic address: jlayden@lumc.edu.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Layden
authors.affiliation: Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO. Electronic address: ellen.burnham@ucdenver.edu.
authors.forename: Ellen L
authors.initials: EL
authors.lastname: Burnham
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017963:Azithromycin / Q000627:therapeutic use*; D005260:Female; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D011014:Pneumonia / Q000150:complications / Q000188:drug therapy*; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018805:Sepsis / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents; D017963:Azithromycin
keywords: Azithromycin; Inflammation; Intensive care unit; Macrolide; Mechanical ventilation; Severe sepsis