SESSION TYPE: Pneumonia Treatment and Antibiotic Resistance
PRESENTED ON: Monday, October 22, 2012 at 04:00 PM - 05:30 PM
PURPOSE: Studies have suggested that macrolides have immunomodulatory and anti-inflammatory properties. The effects of these properties have been well studied in asthma, cystic fibrosis, bronchiectasis and obliterative bronchiolitis. This study examines the relationship of macrolide use and mortality in community-acquired pneumonia.
METHODS: A retrospective cohort study of patients admitted to the hospital with community-acquired pneumonia was performed over a three-year period from January 1, 2007 to December 31, 2010. All patients presented with clinical features of pneumonia (i.e. cough, fever and sputum production) and evidence of infiltrate on chest radiograph. The cohort was divided into two groups based on survival. The use of antibiotics was evaluated for each patient. Administration of macrolide, flouroquinolone or cephalosporin antibiotics on admission was recorded.
RESULTS: There were 273 patients studied with the diagnosis of CAP on admission in the study period. Of these 47 patients subsequently expired and the remaining 226 survived. Of the patients given azithromycin 7.4% expired compared to the 21.4% of patients that expired who were not given azithromycin. A significant difference was observed using Fisher’s exact test (p = 0.0047). Subsequent analysis demonstrates that the odds ratio (OR) is 3.39 (95% CI: 1.38 to 8.35). The use of flouroquinolones or cephalosporins were not associated with statistically significant survival.
CONCLUSIONS: This study suggests that, patients who present with CAP and were given macrolides had a lower risk of dying during their hospital stay. Prior studies have shown that combination therapy in severe CAP with macrolides has shown improved outcomes. This may be due to possibility of atypical bacterial co-infection or the anti-inflammatory and immunomodulatory properties. The mechanism of these properties has not yet been described and remains a topic of ongoing research.
CLINICAL IMPLICATIONS: The study suggests that there is a statistically significant survival benefit afforded to the group of patients given the macrolide antibiotic, azithromycin. However, the mechanism of such benefit remains a topic for further research.
DISCLOSURE: The following authors have nothing to disclose: Nader Mahmood, Hasan Zaidi, Vishal Patel, Hamad Azam, Muhammad Ali, Vincent DeBari, M Anees Khan
No Product/Research Disclosure InformationSt. Joseph's Regional Medical Center, Paterson, NJ