1225. Impact of statin and macrolide use on early survival in pneumococcal pneumonia patients
Session: Poster Abstract Session: Pneumococcal Epidemiology
Saturday, October 22, 2011
Room: Poster Hall B1
Handouts
  • 1225_simitdoshi.pdf (1.1 MB)
  • Background: 

    Mortality rates in patients (pts) with pneumococcal pneumonia remain high despite effective eradication of the causative organism by antimicrobials within 24 hr after therapy is begun. Most deaths occur within the first 2 wk of hospitalization. Interestingly, maximal immunologic and inflammatory responses are also observed during this critical period.  Statins and macrolides have broad immunosuppressive activity. We evaluated the impact of these drugs on survival of pts treated for pneumococcal pneumonia. 

    Methods: 

    All pts diagnosed with pneumococcal pneumonia at the M. E. DeBakey VA Medical Ctr, Houston, TX, from January 2000 to June 2010 were included in this retrospective cohort study. Electronic medical records were reviewed for pt characteristics, statin use at the time of admission and initial antimicrobial therapy. Severity of pneumonia was determined using the well-established Pneumonia Outcomes Research Team (PORT) classification system. A multivariate adjusted Cox proportional hazard model was used to evaluate survival.

    Results: 

    Of 347 pts admitted for pneumococcal pneumonia, 90 (26%) were taking statins at presentation, and 126(36%) were started on a macrolide. Statin users were older (age: 68.0±9.7 vs. 62.5±12.3 yr, p<0.001) and had higher prevalence of diabetes, coronary artery disease, and kidney disease (p<0.05 for each comparison). Liver disease and alcohol consumption were less prevalent among statin users (p<0.05). Statin users had higher mean PORT scores at admission vs. non users(108±32 vs. 96±32, p = 0.002). Survival analysis showed a significantly reduced risk of mortality among statin users at 14 days (HR: 0.39; 0.15-0.98, p=0.04). This result was true for both bacteremic and non-bacteremic pts and across all PORT scores. No differences were noted in pt characteristics between macrolide users and non users. Survival at 14 days was no different in macrolide users vs. non users (HR: 1.40; 0.66-2.97, p=0.37). Combination of macrolides and statins did not improve survival over statins alone at 14 days (HR: 0.32, 0.06-1.77, p=0.19). 

    Conclusion: 

    Pts on statins at the time of admission for pneumococcal pneumonia have better clinical outcomes than those who are not.  Macrolide use did not appear to confer survival benefit.


    Subject Category: C. Clinical studies of bacterial infections and antibacterials including sexually transmitted diseases and mycobacterial infections (surveys, epidemiology, and clinical trials)

    Simit Mahesh Doshi, MBBS1,2, Prathit Kulkarni, MD3, Joshua Liao, BS4 and Daniel Musher, MD, FIDSA4,5, (1)University of Texas School of Public Health, Houston, TX, (2)Infectious Diseases, Michael E. DeBakey Veterans Affairs Medical Center, houston, TX, (3)Baylor College of Medicine, houston, TX, (4)Baylor College of Medicine, Houston, TX, (5)Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX

    Disclosures:

    S. M. Doshi, None

    P. Kulkarni, None

    J. Liao, None

    D. Musher, None

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