Azithromycin Improves Survival for Healthcare-Associated Pneumonia in VA Hospitals

Azithromycin use significantly reduces the risk of 30-day mortality for patients with healthcare-associated pneumonia (HCAP), according to a study using data from patients treated at Veterans Administration acute care hospitals.

Previous studies of patients with HCAP receiving guideline-concordant therapy for HCAP have demonstrated worse survival compared with patients with community-acquired pneumonia (CAP) who receive guideline-concordant therapy for CAP. Eric M Mortensen, MD, MSc, University of Texas Southwest Medical Center, Dallas, and his colleagues hypothesized that this is because azithromycin is a part of CAP concordant therapy but not HCAP concordant therapy.

To investigate whether azithromycin therapy could improve survival in patients hospitalized with HCAP, Dr Mortensen and his team conducted a retrospective national study using Department of Veterans Affairs administrative data of patients hospitalized at any Veterans Administration acute care hospital. The study’s findings were presented at the American Thoracic Society International Conference (May 13-18, 2016; San Francisco, CA).

The study included patients >65 years of age hospitalized with pneumonia in fiscal years 2002 to 2012 with at least 1 HCAP risk factor. HCAP risk factors include prior hospital admission <90 days, nursing home residency, prior outpatient intravenous antibiotics <90 days, and hemodialysis. A total of 26,1138 patients met the inclusion criteria, and 7,864 (29.8%) received azithromycin as part of their inpatient antibiotic therapy.

After adjusting for potential confounders, the analysis showed that 30-day mortality was significantly lower in those who received azithromycin as part of their inpatient antibiotic therapy compared with those who did not (odds ratio, 0.60; 95% CI, 0.55-0.64).

The study demonstrates a significant association between azithromycin use and 30-day mortality in patients with HCAP. The authors suggest that the benefits of azithromycin in this patient population be further investigated in randomized clinical trials.

Mortensen EM, Mtersky ML, Frei CR, Attridge RT, Anzueto A. Azithromycin is associated with improved survival in patients with healthcare-associated pneumonia. A2139. Presented at the American Thoracic Society International Conference. May 13-18, 2016. San Francisco, CA.