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Macrolide therapy is associated with lower mortality in community-acquired bacteraemic pneumonia

2018; Elsevier BV; Volume: 140; Linguagem: Inglês

10.1016/j.rmed.2018.05.020

1532-3064

Forest W. Arnold, Gustavo Lopardo, Timothy L. Wiemken, Robert Kelley, Paula Peyrani, William A. Mattingly, Charles Feldman, Martin Gnoni, Rosemeri Maurici, Julio A. Ramírez, Forest W. Arnold, Paula Peyrani, Julio A. Ramírez, Kwabena Ayesu, Thomas M. File, Steven D. Burdette, Stephen P. Blatt, Marcos I. Restrepo, José Bordón, Peter Groß, Daniel M. Musher, Thomas J. Marrie, Karl Heinz Weiss, Jorge Roig, H. Lode, Tobias Welte, Stefano Aliberti, Francesco Blasi, Roberto Cosentini, Delfino Legnani, Fabio Franzetti, Nicola Montano, Giulia Cervi, Paolo Giorgi Rossi, Antonio Voza, Belinda Ostrowsky, Alberto Pesci, Stefano Nava, Pierluigi Viale, Vanni Galavatti, Aruj Patricia, Carlos Dimas, Roberto Piro, Claudio Viscoli, Antoní Torres, Vincenzo Valenti, Daniel Portela Ojales, María Bodí, José Antonio Porras, Jordi Rello, Rosario Menéndez, Daiana Stolz, Philipp Schüetz, Sebastian Haubitz, James D. Chalmers, Tom Fardon, Guillermo Benchetrit, Eduardo Rodrı́guez, Jorge Corral, José Pablo Miramontes‐González, Lautaro De Vedia, Gustavo Lopardo, Carlos M. Luna, Jorge Martínez, Lucía Marzoratti, Maria Soledad Rodrı́guez González, Alejandro J. Videla, Federico Saavedra, Horacio Pérez López, Martin Gnoni, José Pablo Miramontes‐González, Carlos Victorio, Fernando Riera, Patricio Jiménez, Patricia Fernández, Maria Parada, Alejandro Díaz Fuenzalida, Raúl Riquelme, Manuel Barros, Juan Manuel Rocha Luna, Ivan Toala, Guillermo Arbo Oze de Morvil, Ricardo Fernández, Gonzalo Aiello, Pablo Alvarez, Ana Soca, Federico Arteta, J. Fernández Delgado, Gur Levy, Ludwig Rivero, Benito Rodrı́guez, Mario Perez Mirabal, Marilyn Mateo, Myrna Mendoza, Charles Feldman,

Pneumocystis jirovecii pneumonia detection and treatment

Community-acquired pneumonia (CAP) has a potential complication of bacteremia. The objective of this study was to define the clinical outcomes of patients with CAP and bacteremia treated with and without a macrolide.Secondary analysis of the Community-Acquired Pneumonia Organization database of hospitalized patients with CAP. Patients with a positive blood culture were categorized based on the presence or absence of a macrolide in their initial antimicrobial regimen, and severity of their CAP. Outcomes included in-hospital all-cause mortality, 30-day mortality, length of stay, and time to clinical stability.Among 549 patients with CAP and bacteremia, 247 (45%) were treated with a macrolide and 302 (55%) were not. The primary pathogen was Streptococcus pneumoniae (74%). Poisson regression with robust error variance models were used to compare the adjusted effects of each study group on the outcomes. The unadjusted 30-day mortality was 18.4% in the macrolide group, and 29.6% in the non-macrolide group (adjusted relative risk (aRR)0.81; 95% confidence interval (CI)0.50-1.33; P = 0.41). Unadjusted in-hospital all-cause mortality was 7.3% in the macrolide group, and 18.9% in the non-macrolide group (aRR 0.54, 95% CI 0.30-0.98; P = 0.043). Length of stay and time to clinical stability were not significantly different.In-hospital mortality, but not 30-day mortality, was significantly better in the macrolide group. Our data support the use of a macrolide in hospitalized patients with CAP and bacteraemia.