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Original Research: Chest Infections |

Impact of Macrolide Therapy in Patients Hospitalized With Pseudomonas aeruginosa Community-Acquired PneumoniaMacrolide Therapy in Pseudomonas aeruginosa

Elena Laserna, MD; Oriol Sibila, MD; Juan Felipe Fernandez, MD; Diego Jose Maselli, MD; Eric M. Mortensen, MD; Antonio Anzueto, MD; Grant Waterer, MD; Marcos I. Restrepo, MD, FCCP
Author and Funding Information

From the Hospital Comarcal de Mollet (Dr Laserna), Mollet del Vallès, Spain; University of Texas Health Science Center at San Antonio (Drs Laserna, Sibila, Fernandez, Maselli, Anzueto, and Restrepo), San Antonio, TX; Servei de Pneumologia (Dr Sibila), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Institut d’Investigació Biomedica Sant Pau (IIB Sant Pau) (Dr Sibila), Barcelona, Spain; South Texas Veterans Health Care System (Drs Fernandez, Maselli, Anzueto, and Restrepo), San Antonio, TX; North Texas Veterans Health Care System (Dr Mortensen), Dallas, TX; University of Texas Southwestern Medical Center (Dr Mortensen), Dallas, TX; University of Western Australia (Dr Waterer), Perth, WA, Australia; and Feinberg School of Medicine (Dr Waterer), Northwestern University, Chicago, IL.

Correspondence to: Marcos I. Restrepo, MD, FCCP, South Texas Veterans Health Care System, Audrey L. Murphy Division, 7400 Merton Minter Blvd, San Antonio, TX 78229; e-mail: restrepom@uthscsa.edu


Funding/Support: This research was supported by Howard Hughes Medical Institute faculty [Start-up Grant 00378-001] and a Department of Veterans Affairs Veterans Integrated Service Network 17 new faculty grant. Drs Laserna and Sibila are supported by Sociedad Espanola de Neumologia y Cirugia Toracica (SEPAR), Societat Catalana de Pneumologia (SOCAP), and Fundacio Catalana de Pneumologia (FUCAP). Dr Sibila is supported by Instituto de Salud Carlos III [BAE11/00102]. Dr Restrepo’s time is partially protected by K23-HL096054 from the National Heart, Lung, and Blood Institute.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(5):1114-1120. doi:10.1378/chest.13-1607
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Background:  Several studies have described a clinical benefit of macrolides due to their immunomodulatory properties in various respiratory diseases. We aimed to assess the effect of macrolide therapy on mortality in patients hospitalized for Pseudomonas aeruginosa community-acquired pneumonia (CAP).

Methods:  We performed a retrospective population-based study of > 150 hospitals in the US Veterans Health Administration. Patients were included if they had a diagnosis of CAP and P aeruginosa was identified as the causative pathogen. Patients with health-care-associated pneumonia and immunosuppression were excluded. Macrolide therapy was considered when administered within the first 48 h of admission. Univariate and multivariable analyses were performed using 30-day mortality as the dependent measure.

Results:  We included 402 patients with P aeruginosa CAP, of whom 171 (42.5%) received a macrolide during the first 48 h of admission. These patients were older and white. Macrolide use was not associated with lower 30-day mortality (hazard ratio, 1.14; 95% CI, 0.70-1.83; P = .5). In addition, patients treated with macrolides had no differences in ICU admission, use of mechanical ventilation, use of vasopressors, and length of stay (LOS) compared with patients not treated with macrolides. A subgroup analysis among patients with P aeruginosa CAP in the ICU showed no differences in baseline characteristics and outcomes.

Conclusions:  Macrolide therapy in the first 48 h of admission is not associated with decreased 30-day mortality, ICU admission, need for mechanical ventilation, and LOS in hospitalized patients with P aeruginosa CAP. Larger cohort studies should address the benefit of macrolides as immunomodulators in patients with P aeruginosa CAP.

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