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Impact of macrolide therapy on mortality for patients with severe sepsis due to pneumonia

M I Restrepo1, E M Mortensen, G W Waterer

  • 1Veterans Evidence-Based Research Dissemination Implementation Center, Audie L. Murphy Veterans Affairs Hospital, San Antonio, TX, USA. restrepom@uthscsa.edu

The European Respiratory Journal
|September 5, 2008
PubMed

Insights

Macrolide therapy may reduce mortality in severe sepsis patients with pneumonia. This retrospective study found macrolide use was linked to lower 30- and 90-day death rates, especially with resistant pathogens.

Area of Science:

  • Critical Care Medicine
  • Infectious Diseases
  • Pharmacology

Background:

  • Macrolides are antibiotics with potential beneficial effects in patients susceptible to infections.
  • Severe sepsis, particularly pneumonia, presents a significant mortality risk.
  • The impact of macrolide therapy on mortality in severe sepsis secondary to pneumonia requires further investigation.

Purpose of the Study:

  • To evaluate the effect of macrolide therapy on 30- and 90-day mortality in patients diagnosed with severe sepsis caused by pneumonia.
  • To assess the association between macrolide use and mortality outcomes in this patient cohort.

Main Methods:

  • Retrospective cohort study conducted at two tertiary teaching hospitals.
  • Inclusion criteria: diagnosis, chest radiography, and discharge diagnosis of pneumonia with clinical severe sepsis.
  • Macrolide exposure defined as receiving at least one dose within 48 hours of admission; mortality assessed at 30 and 90 days.

Main Results:

  • Of 237 severe sepsis patients with pneumonia, 104 received macrolides.
  • Overall mortality was 20.3% at 30 days and 24.5% at 90 days.
  • Multivariable analysis revealed macrolide use was associated with significantly decreased 30-day (HR 0.3) and 90-day (HR 0.3) mortality, particularly in patients with macrolide-resistant pathogens (HR 0.1).

Conclusions:

  • Macrolide therapy demonstrated an association with reduced mortality in patients with severe sepsis due to pneumonia.
  • This protective effect was more pronounced in cases involving macrolide-resistant pathogens.
  • Further confirmatory studies are warranted to establish the therapeutic role of macrolides in sepsis management.

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