PURPOSE: Recent studies suggest that macrolides may have beneficial short term effects for patients at risk for pneumonia. However, the evidence is limited regarding long term outcomes of patients that require mechanical ventilation with severe sepsis. Our objective was to examine the effect of macrolide therapy on 6- and 12-month mortality for patients with severe sepsis that required mechanical ventilation.
METHODS: A retrospective analyses of Department of Veterans Affairs administrative data of hospitalized patients aged >/=65 years with a discharge diagnosis of sepsis (by ICD-9 codes 0.38 and 0.20) in fiscal years 2002-2007,with at least one organ failure, required admission to the ICU, received at least 1 dose of antibiotics within 48 hours of admission, and had at least 1 year of outpatient care before the index admission were included. Primary outcomes were 6- and 12-month mortality.
RESULTS: Severe sepsis was present in 6,595 subjects admitted to the ICU, 3,787 (57.4%) of which required mechanical ventilation. The 6- and 12-month mortality for the whole cohort was 76% and 80%, respectively. Macrolides were administered to 610 (16.5%). A multivariable regression analysis showed that the macrolide therapy was associated with decreased 6 months (63% vs. 78%, odds ratio [OR] 0.57, 95% Confidence Interval [CI] 0.47-0.70) and 12 -month mortality (69% vs. 83%, OR 0.54, 95% CI 0.44-0.67) when compared to non-macrolide therapy after adjusting for potential confounders.
CONCLUSIONS: Macrolide use was associated with decreased long term (at 6 and 12 months) mortality in mechanically ventilated patients with severe sepsis. Confirmatory randomized control trials are needed to determine whether macrolide therapy may be protective for long term outcomes in severe septic patients requiring mechanical ventilation.
CLINICAL IMPLICATIONS: Macrolides may have long term effect on severe septic patients that require mechanical ventilation and may become the standard of care for the treatment of sepsis.
DISCLOSURE: Marcos Restrepo: Grant monies (from sources other than industry): NIH/NHLBI by Award Number K23HL096054
The following authors have nothing to disclose: Eric Mortensen, Antonio Anzueto
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