RT Journal Article
SR Electronic
T1 Macrolide therapy is associated with lower 30-day mortality in patients with non-pneumonia and pneumonia severe sepsis
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP p2554
VO 38
IS Suppl 55
A1 Marcos Restrepo
A1 Eric Mortensen
A1 Laurel Copeland
A1 Brandie Nakashima
A1 MaryJo Pugh
A1 Antonio Anzueto
YR 2011
UL http://erj.ersjournals.com/content/38/Suppl_55/p2554.abstract
AB Background: Recent studies suggest that macrolides may have beneficial effects for patients at risk for certain infections. However, the evidence is limited to events associated with pneumonia.Aim: We examined the effect of macrolide therapy on 30-day mortality for patients with severe sepsis caused by pneumonia compared to non-pneumonia severe sepsis.Methods: A retrospective administrative data of hospitalized inpatients aged >/=65 years with a discharge diagnosis of sepsis (by ICD-9 codes 0.38 and 0.20) in fiscal years 2002-2007, and at least 1 year of Department of Veterans Affairs outpatient care before the index admission were included. Severe sepsis was defined as sepsis with at least one organ failure. Stratification was done according to the source in severe sepsis secondary to community acquired pneumonia (SSCAP) vs. non-pneumonia severe sepsis NCAP-SS). Primary outcome was 30-day mortality.Results: Severe sepsis was present in 15,308 subjects, out of whom 1,817 (12%) received macrolides. SSCAP occurred in 24% of the patients vs. 76% in NCAP-SS. Mortality was 46% at 30 days for the severe sepsis group. The use of macrolide therapy was associated with decreased mortality at 30 days in the SSCAP group (31% vs. 51%, p<.001) and in the NCAP-SS group (36% vs. 47%, p<.001) when compared to non-macrolide therapy.Conclusion: Macrolide use was associated with decreased 30-day mortality in patients with severe sepsis due to pneumonia and non-pneumonia, respectively. Confirmatory randomized control trials are needed to determine whether macrolide therapy may be protective for patients with sepsis and the mechanism of this association.