1236. Sequential Administration of Beta-lactams and Macrolides on the Outcomes of Hospitalized Patients with Community-Acquired Pneumonia: Results from the CAPO International Cohort Study
Session: Poster Abstract Session: Clinical Infectious Diseases: Respiratory Infections
Friday, October 28, 2016
Room: Poster Hall
  • Sequential administration.jpg (140.5 kB)
  • Background: Guidelines for CAP recommend administration of beta-lactam plus macrolides since this combination decreases mortality. Explanations for decreased mortality include: 1) macrolides are effective against atypical pathogens and 2) macrolides act as anti-inflammatory agents. In patients with meningitis, the anti-inflammatory agent (steroids) are administered before the use of beta-lactam antibiotics to improve clinical outcomes. Data on the clinical outcomes of patients with CAP are lacking regarding the effect of macrolides when given before or after beta-lactams. The objective of this study was to compare clinical outcomes when macrolides are used before or after administration of beta-lactams.

    Methods: This was a secondary data analysis of the Community-Acquired Pneumonia Organization (CAPO) International Cohort Study database. Patients receiving a combination of beta-lactams plus macrolides for empiric therapy were included. Patients given beta-lactams and macrolides within 1 hour or more than 24 hours apart were excluded. TCS and LOS were analyzed with the Kaplan-Meier method, and log-rank tests applied to evaluate differences between both groups. To define the adjusted association between macrolide vs. beta-lactam timing on the risk of in-hospital mortality, a log-binomial regression model was used.

    Results: A total of 555 patients were included, 63 with a macrolide first and 492 with a beta-lactam first. Median (IQR) time to clinical stability was 4 days (2.5)for patients receiving a macrolide first and 5 days (5) for patients receiving a beta-lactam first (P=<0.001). Median (IQR) time to clinical stability was 5 days (5) for patients receiving a macrolide first and 8 days (7) for patients receiving a beta-lactam first (P=<0.001). The adjusted percent in-hospital mortality was 1% for patients receiving a macrolide first and 8% for patients receiving a beta-lactam first (P=0.158).

    Conclusion: These data suggest that, although not statistically significant, there is a clinically relevant decrease in in-hospital mortality if a macrolide is given before a beta-lactam. Since macrolides may decrease mortality only when given prior to beta-lactam antibiotics, their activity is likely due to anti-inflammatory effects and prevention of bacterial lysis as opposed to coverage of atypical pathogens.

    Paula Peyrani, MD1, Anupama Raghuram, MD1, Forest Arnold, DO, MSc, FIDSA1, Timothy Wiemken, PhD1, Robert Kelley, PhD1, Mark Metersky, MD2, Julio Ramirez, MD1 and the CAPO Investigators, (1)Division of Infectious Diseases, University of Louisville, Louisville, KY, (2)Pulmonary and Critical Care Medicine, University of Connecticut School of Medicine, Farmington, CT


    P. Peyrani, None

    A. Raghuram, None

    F. Arnold, None

    T. Wiemken, None

    R. Kelley, None

    M. Metersky, None

    J. Ramirez, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.