Impact of macrolide therapy on mortality for patients with severe sepsis due to pneumonia

¹ From the VERDICT, Audie L Murphy VA Hospital; and Pulmonary and Critical Care Medicine
² From the VERDICT, Audie L Murphy VA Hospital; and Dept of Medicine, Divisions of General Medicine
³ University of Western Australia, Perth
⁴ Northwestern University Feinberg School of Medicine
⁵ University of Texas Health Science Center at San Antonio, Department of Pathology
⁶ Pulmonary and Critical Care Medicine

^* To whom correspondence should be addressed. E-mail: restrepom{at}uthscsa.edu.

	Abstract

Recent studies suggest that macrolides may have beneficial effects for patients at risk for certain infections. We examined the effect of macrolide therapy on 30- and 90-day mortality for patients with severe sepsis caused by pneumonia.

A retrospective cohort study conducted at two tertiary teaching hospitals. Eligible subjects were admitted with a diagnosis of, had a chest x-ray consistent with, and had a discharge diagnosis of pneumonia and clinical criteria of severe sepsis. Subjects were considered to be on a macrolides if they received at least one dose within 48 hours of admission.

Severe sepsis was present in 237 subjects (30.1%) of which 104 (43.9%) received macrolides. Mortality was 20.3% at 30-days and 24.5% at 90-days. In the multivariable analysis, the use of macrolide was associated with decreased mortality at 30-days (hazard ratio [HR] 0.3, 95% confidence interval [CI] 0.2–0.7) and at 90-days (HR 0.3, 95% CI 0.2–0.6) in patients with severe sepsis and in patients with macrolide resistant pathogens (HR 0.1, 95% CI 0.02–0.5).

Macrolide use was associated with decreased mortality in patients with severe sepsis due to pneumonia and macrolide resistant pathogens. Confirmatory studies are needed to determine whether macrolide therapy may be protective for patients with sepsis.

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