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Effect of Macrolide Antibiotics on In-Hospital Mortality Among Acute Exacerbation of COPD Patients: A Propensity
Thotsaporn Morasert1, Orakarn Kriengwattanakul2, Prapasri Kulalert3
1Pulmonary and Critical Care Medicine, Department of Internal Medicine, Suratthani Hospital, Surat Thani, 84000, Thailand.
Objective:
This study aimed to assess whether the short-term use of macrolide antibiotics during hospitalization can reduce in-hospital all-cause mortality compared to non-macrolide treatment in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).
Methods:
A propensity score (PS) matching analysis was performed using retrospective data from the admission records of AECOPD patients in the medical general ward and medical intensive care unit of a tertiary care center between October 2015 and September 2018. The multivariable Cox proportional hazard model was performed to eliminate residual confounding after the PS analysis.
Results:
The mortality rate was 11.1% of 1528 admissions in the PS matching cohort. Approximately 70% of patients had respiratory failure requiring intubation on initial admission, and 34% had pneumonia. Macrolide treatment significantly reduced in-hospital mortality among AECOPD patients (adjusted hazard ratio, 0.55; 95% confidence interval 0.32-0.96; P=0.034). Clarithromycin was the most commonly prescribed macrolide (80%).
Conclusion:
Macrolide antibiotics reduced in-hospital mortality in hospitalized AECOPD patients. The combination of antimicrobial and immunomodulatory effects of macrolide treatment could play an essential role.
Insights
Short-term macrolide antibiotics significantly reduced in-hospital mortality for patients hospitalized with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). This finding highlights macrolides
Area of Science:
- Pulmonology
- Infectious Diseases
- Pharmacology
Background:
- Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a significant cause of hospitalization and mortality.
- Identifying effective treatments to reduce mortality in hospitalized AECOPD patients is crucial.
Purpose of the Study:
- To evaluate the impact of short-term macrolide antibiotic use on in-hospital all-cause mortality in AECOPD patients.
- To compare mortality rates between macrolide and non-macrolide treatment groups.
Main Methods:
- Retrospective analysis of AECOPD patient admission records from October 2015 to September 2018.
- Propensity score (PS) matching to control for confounding factors.
- Multivariable Cox proportional hazard model to further adjust for residual confounding.
Main Results:
- The study included 1528 admissions in the PS matching cohort, with an overall mortality rate of 11.1%.
- Macrolide treatment was associated with a significant reduction in in-hospital mortality (adjusted hazard ratio: 0.55; 95% CI: 0.32-0.96; P=0.034).
- Clarithromycin was the predominant macrolide prescribed (80%).
Conclusions:
- Short-term macrolide antibiotic administration effectively reduces in-hospital mortality among AECOPD patients.
- The combined antimicrobial and immunomodulatory properties of macrolides may contribute to their beneficial effect.
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