PURPOSE: Recent studies suggest that macrolides may have beneficial effects for patients at risk for some types of infections. We examined the effect of macrolide therapy on short and long term mortality for patients with severe sepsis caused by community-acquired pneumonia.
METHODS: 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 ICD-9 diagnosis of pneumonia and clinical criteria of severe sepsis [ACCP consensus]. Subjects were excluded if they were “comfort measures only” or transferred from another acute care hospital. Subjects were considered to be on a medication if they were taking on admission or while in the hospital.
RESULTS: Data was abstracted in 787 patients at two hospitals: 237 (30.1%) meet criteria for severe sepsis and of which 104 (43.9%) received macrolide therapy on admission. Mortality was 20.3% at 30-days and 24.5% at 90-days. In the multivariate regression analysis, after adjusting for potential confounders (PSI score and guideline concordant therapy), the use of macrolides for severe sepsis was associated with decreased mortality at 30-days (odds ratio 0.43, 95% confidence interval 0.21-0.90) and at 90-days (OR 0.40, 95% CI 0.20-0.77).
CONCLUSION: Macrolide use was associated with decreased 30- and 90-day mortality in patients with severe sepsis due to community-acquired pneumonia. Confirmatory studies and randomized controlled studies are needed to determine the mechanisms of this protective effect.
CLINICAL IMPLICATIONS: Potential use of macrolide therapy may have significant implications in outcomes, cost and future clinical intervention trials in patients with severe sepsis.
DISCLOSURE: Marcos Restrepo, None.