0
Chest Infections |

Azithromycin and Mortality in Streptococcus pneumoniae Pneumonia

A. Shorr*, MD; M. Zilberberg, MD; S. Micek, PharmD; M. Kollef, MD
Author and Funding Information

Washington Hospital Center, Washington, DC


Chest. 2012;142(4_MeetingAbstracts):147A. doi:10.1378/chest.1383017
Text Size: A A A
Published online

Abstract

SESSION TYPE: Pneumonia Treatment and Antibiotic Resistance

PRESENTED ON: Monday, October 22, 2012 at 04:00 PM - 05:30 PM

PURPOSE: S. pneumoniae (SP) represents a major pathogen in community-acquired pneumonia (CAP) and remains associated with substantial mortality. Prior research suggests that use of macrolides in CAP results in improved survival. However, earlier efforts indicating a beneficial effect of macrolide use have been limited. These analyses have pooled patients with CAP irrespective of pathogen, addressed only critically ill patients, and/or failed to adjust for the appropriateness and of initial antibiotic therapy. We sought to clarify the relationship between survival and macrolide use in SP pneumonia.

METHODS: We evaluated adult patients admitted with a diagnosis of SP pneumonia (Jan-Dec 2010). The diagnosis of pneumonia required a compatible clinical syndrome and radiographic evidence of an infiltrate. The identification of SP was based on a culture from blood, pleural fluid, or respiratory secretions or a urinary antigen. Mortality at 28 days served as the primary endpoint, and we compared subjects given a macrolide (only Azithromycin was utilized during the study period) to those not treated with a macrolide. Co-variates of interest included demographics, severity of illness, comorbidities, and infection related characteristics (eg, appropriateness of initial treatment, presence of bacteremia). After unadjusted analyses we employed Cox regression modeling to calculate adjusted hazard ratios (AHRs) to assess the independent impact of macrolide treatment of mortality.

RESULTS: cohort included 187 subjects (mean age: 67.0 ± 8.2 years, 50.3% male, 5.9% admitted to the ICU). The most frequently utilized non-macrolide antibiotics included: Ceftriaxone (n=111), Cefipeme (n=31), and Moxifloxacin (n=22). Approximately 2/3rds of the cohort received Azithromycin. Crude mortality was lower in persons given Azithromycin (5.6% vs. 23.6%, p<0.01). The final survival model included four variables: age (AHR 1.02; 95% CI: 0.99-1.06), need for mechanical ventilation (AHR 2.28; 95% CI: 0.83-6.27), initial appropriate therapy (AHR 0.26; 95% CI: 0.10-0.66), and Azithromycin use (AHR 0.32; 95% CI: 0.13-0.79).

CONCLUSIONS: SP pneumonia remains associated with significant mortality. Azithromycin treatment, along with another appropriate antibiotic, is associated with significantly higher survival rates. The impact of Azithromycin is independent of multiple potential confounders.

CLINICAL IMPLICATIONS: Addition of Azithromycin should be considered when treating patients with pneumonia at risk for SP.

DISCLOSURE: A. Shorr: Consultant fee, speaker bureau, advisory committee, etc.: Astellas, Bayer, Cubist, Pfizer, Trius, Theravance

M. Zilberberg: Consultant fee, speaker bureau, advisory committee, etc.: Astellas, Cubist, Optimer, Pfizer

S. Micek: Consultant fee, speaker bureau, advisory committee, etc.: Cubist, Forrest

M. Kollef: Consultant fee, speaker bureau, advisory committee, etc.: Trius, Cubist, J and J, Bayer, Forrest

No Product/Research Disclosure Information

Washington Hospital Center, Washington, DC

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543