Azithromycin and survival in Streptococcus pneumoniae pneumonia: a retrospective study
Andrew F Shorr1, Marya D Zilberberg, Jason Kan
1Pulmonary and Critical Care Medicine Division, Washington Hospital Center, Washington, District of Columbia, USA.
Objective:
Streptococcus pneumoniae (SP) represents a major pathogen in pneumonia. The impact of azithromycin on mortality in SP pneumonia remains unclear. Recent safety concerns regarding azithromycin have raised alarm about this agent's role with pneumonia. We sought to clarify the relationship between survival and azithromycin use in SP pneumonia.
Design:
Retrospective cohort.
Setting:
Urban academic hospital.
Participants:
Adults with a diagnosis of SP pneumonia (January-December 2010). The diagnosis of pneumonia required a compatible clinical syndrome and radiographic evidence of an infiltrate.
Intervention:
None.
Primary And Secondary Outcome Measures:
Hospital mortality served as the primary endpoint, and we compared patients given azithromycin with those not treated with this. Covariates of interest included demographics, severity of illness, comorbidities and infection-related characteristics (eg, appropriateness of initial treatment, bacteraemia). We employed logistic regression to assess the independent impact of azithromycin on hospital mortality.
Results:
The cohort included 187 patients (mean age: 67.0±8.2 years, 50.3% men, 5.9% admitted to the intensive care unit). The most frequently utilised non-macrolide antibiotics included: ceftriaxone (n=111), cefepime (n=31) and moxifloxacin (n=22). Approximately two-thirds 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, need for mechanical ventilation, initial appropriate therapy and azithromycin use. The adjusted OR for mortality associated with azithromycin equalled 0.26 (95% CI 0.08 to 0.80, p=0.018).
Conclusions:
SP pneumonia generally remains associated with substantial mortality while azithromycin treatment is associated with significantly higher survival rates. The impact of azithromycin is independent of multiple potential confounders.
Insights
Azithromycin use in Streptococcus pneumoniae pneumonia patients was associated with significantly higher survival rates. This finding held true even after accounting for other factors influencing patient outcomes.
Area of Science:
- Infectious Diseases
- Pulmonology
- Clinical Pharmacology
Background:
- Streptococcus pneumoniae (SP) is a leading cause of pneumonia.
- The role of azithromycin in SP pneumonia outcomes requires clarification due to recent safety concerns.
Purpose of the Study:
- To investigate the association between azithromycin use and hospital mortality in patients with SP pneumonia.
- To determine if azithromycin's impact on survival is independent of other clinical factors.
Main Methods:
- Retrospective cohort study of adult patients diagnosed with SP pneumonia.
- Hospital mortality was the primary endpoint, analyzed using logistic regression.
- Covariates included demographics, illness severity, comorbidities, and treatment appropriateness.
Main Results:
- The study included 187 patients; two-thirds received azithromycin.
- Crude mortality was lower in the azithromycin group (5.6% vs. 23.6%).
- Adjusted analysis showed azithromycin use was associated with a 74% reduction in mortality (OR 0.26, p=0.018).
Conclusions:
- Azithromycin treatment is linked to significantly improved survival rates in SP pneumonia.
- The beneficial effect of azithromycin on survival is independent of key confounding variables.
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