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. 2022 Dec 19;75(12):2219-2224.
doi: 10.1093/cid/ciac317.

The Effect of Macrolides on Mortality in Bacteremic Pneumococcal Pneumonia: A Retrospective, Nationwide Cohort Study, Israel, 2009-2017

Michal Chowers  1   2 , Shiran Gerassy-Vainberg  3   4 , Ronit Cohen-Poradosu  2   5 , Yonit Wiener-Well  6   7 , Jihad Bishara  2   8 , Yasmin Maor  2   9 , Oren Zimhony  7   10 , Bibiana Chazan  4   11 , Bat-Sheva Gottesman  1   2 , Ron Dagan  12 , Gili Regev-Yochay  2   13 ; IAIPD research group
Collaborators, Affiliations

The Effect of Macrolides on Mortality in Bacteremic Pneumococcal Pneumonia: A Retrospective, Nationwide Cohort Study, Israel, 2009-2017

Michal Chowers et al. Clin Infect Dis. .

Abstract

Background: Previous cohort studies of pneumonia patients reported lower mortality with advanced macrolides. Our aim was to characterize antibiotic treatment patterns and assess the role of quinolones or macrolides in empirical therapy.

Materials: An historical cohort, 1 July 2009 to 30 June 2017, included, through active surveillance, all culture-confirmed bacteremic pneumococcal pneumonia (BPP) among adults in Israel. Cases without information on antibiotic treatment were excluded. Logistic regression analysis was used to assess independent predictors of in-hospital mortality.

Results: A total of 2016 patients with BPP were identified. The median age was 67.2 years (interquartile range [IQR] 53.2-80.6); 55.1% were men. Lobar pneumonia was present in 1440 (71.4%), multi-lobar in 576 (28.6%). Median length of stay was 6 days (IQR 4-11). A total of 1921 cases (95.3%) received empiric antibiotics with anti-pneumococcal coverage: ceftriaxone, in 1267 (62.8%). Coverage for atypical bacteria was given to 1159 (57.5%), 64% of these, with macrolides. A total of 372 (18.5%) required mechanical ventilation, and 397 (19.7%) died. Independent predictors of mortality were age (odds ratio [OR] 1.051, 95% confidence interval [CI] 1.039, 1.063), being at high-risk for pneumococcal disease (OR 2.040, 95% CI 1.351, 3.083), multi-lobar pneumonia (OR 2.356, 95% CI 1.741, 3.189). Female sex and macrolide therapy were predictors of survival: (OR 0.702, 95% CI .516, .955; and OR 0.554, 95% CI .394, .779, respectively). Either azithromycin or roxithromycin treatment for as short as two days was predictor of survival. Quinolone therapy had no effect.

Conclusions: Empirical therapy with macrolides reduced odds for mortality by 45%. This effect was evident with azithromycin and with roxithromycin. The effect did not require a full course of therapy.

Keywords: azithromycin; mortality; pneumococcal pneumonia; roxithromycin.

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Conflict of interest statement

Potential conflicts of interest. R. D. has received grants/research support from Pfizer, MedImmmune/AstraZeneka, and Merck Sharp & Dohme (paid to Ben Gurion University); has been a scientific consultant for MeMed, Merck Sharp & Dohme, and Pfizer (paid to ISRAVAX) and a speaker for GlaxoSmithKline, Merck Sharp & Dohme, Sanofi Pasteur and Pfizer (paid to ISRAVAX); received payment for expert testimony from Pfizer (paid to ISRAVAX); received support for attending meetings and/or travel from Pfizer and MSD; and participated on a DSMB or AB for Pfizer and MSD (paid to ISRAVAX). G. R. has received a research grant from Pfizer and has been a scientific consultant for Teva and Merck; and reports payment or honoraria for lectures from MSD (COVID pandemic, unrelated to the topic of the study); participation on an Advisory Board for Moderna and AstraZeneca. Y. W.-W. reports grants or contracts unrelated to this work from Madaait, Shaare Zedek Medical Center, Jerusalem center of computerized individualized medicine, and Faculty of Medicine, Hebrew University. S. G.-V. reports consulting fees from CytoReason and Photopill. Y. Maor reports a quality grant unrelated to this work from Pfizer; payment or honoraria for lectures from MSD and Pfizer; participation on a DSMB or AB related to COVID-19 for MSD; and leadership or fiduciary role related to COVID-19 and vaccination with the Ministry of Health Israel. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Comment in

  • Bacteremic Pneumococcal Pneumonia.
    Paul M, Leibovici L. Paul M, et al. Clin Infect Dis. 2022 Oct 12;75(8):1484. doi: 10.1093/cid/ciac414. Clin Infect Dis. 2022. PMID: 35818903 No abstract available.

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