IMPLICATIONS FOR MACROLIDE TREATMENT IN COMMUNITY-ACQUIRED PNEUMONIA

Study objectives: To identify associated clinical parameters, concurre nt respiratory tract infections, and the association between macrolide -based therapy and mortality in patients with community-acquired pneum onia ascribed to atypical. Design: Secondary analysis of prospective, cross-sectional study. Setting: Tertiary care hospital. Patients: Thre e hundred eighty-five consecutive patients who were admitted to the Jo hns Hopkins Hospital from November 11, 1990, through November 10, 1991 , and treated for community-acquired pneumonia. Results: An atypical p athogen was identified in 29 of 385 adults (7.5%). A second pathogen w as detected in 16 of 29 patients (55.2%) in whom an atypical pathogen was detected, compared with 13 of 137 patients (9.5%) in whom conventi onal bacterial pathogens were detected (odds ratio, 10.22; 95% confide nce interval, 3.1 to 28.8; p<0.0001). During hospitalization, only fou r patients (13.8%) with detection of an atypical pathogen received at least 7 days of either a macrolide or tetracycline. No patient identif ied to have an atypical pathogen died. For patients who either provide d paired sera or who died, 24 of 197 (12.2%) had atypical pathogens de tected. Conclusions: Despite vigorous study methods, atypical pathogen s were uncommon in our hospitalized population. A second concurrent re spiratory pathogen was identified for most patients with atypical pneu monia. Although macrolide use was rare in this patient population, mor tality was zero for patients in whom an atypical pathogen was detected , affirming that macrolide-based therapy need not be routine in the th erapeutic management of community-aquired pneumonia.