Evidence map›Paper›PMID 24489569›Full record

ArticleThe Canadian journal of infectious diseases & medical microbiology = Journal canadien des maladies infectieuses et de la microbiologie medicale2013

Macrolide use in the treatment of critically ill patients with pneumonia: Incidence, correlates, timing and outcomes.

Wendy I Sligl, Holly Hoang, Dean T Eurich, Atul Malhotra, Thomas J Marrie, Sumit R Majumdar

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The Canadian journal of infectious diseases & medical microbiology = Journal canadien des maladies infectieuses et de la microbiologie medicale, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
0.8field-weighted citation impact, top 27% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 12 citations in OpenAlex.

  1. Article
  2. Observational
  3. Article
  4. Review
  5. Severe community-acquired pneumonia.Critical care clinics · 2013
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 3 institutions in 2 countries.

Wendy I SliglDivisions of Critical Care Medicine and Infectious Diseases, University of Alberta, Edmonton, Alberta;
Holly HoangDivision of Infectious Diseases, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta;
Dean T EurichDepartment of Public Health Sciences, School of Public Health, University of Alberta, Edmonton, Alberta;
Atul MalhotraDepartment of Medicine, Faculty of Medicine, Harvard University, Boston, Massachusetts, USA;
Thomas J MarrieDepartment of Medicine, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia;
Sumit R MajumdarDepartment of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta.
University of Alberta · CADalhousie University · CAHarvard University · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundMacrolide antibiotics are commonly used to treat pneumonia despite increasing antimicrobial resistance. Evidence suggests that macrolides may also decrease mortality in severe sepsis via immunomodulatory properties.

objectiveTo evaluate the incidence, correlates, timing and mortality associated with macrolide-based treatment.

methodsA population-based cohort of critically ill adults with pneumonia at five intensive care units in Edmonton, Alberta, was prospectively followed over two years. Data collected included disease severity (Acute Physiology and Chronic Health Evaluation [APACHE] II score), pneumonia severity (Pneumonia Severity Index score), comorbidities, antibiotic treatments at presentation and time to effective antibiotic. The independent association between macrolide-based treatment and 30-day all-cause mortality was examined using multivariable Cox regression. A secondary exploratory analysis examined time to effective antimicrobial therapy.

resultsThe cohort included 328 patients with a mean Pneumonia Severity Index score of 116 and a mean APACHE II score of 17; 84% required invasive mechanical ventilation. Ninety-one (28%) patients received macrolide-based treatments, with no significant correlates of treatment except nursing home residence (15% versus 30% for nonresidents [P=0.02]). Overall mortality was 54 of 328 (16%) at 30 days: 14 of 91 (15%) among patients treated with macrolides versus 40 of 237 (17%) for nonmacrolides (adjusted HR 0.93 [95% CI 0.50 to 1.74]; P=0.8). Patients who received effective antibiotics within 4 h of presentation were less likely to die than those whose treatment was delayed (14% versus 17%; adjusted HR 0.50 [95% CI 0.27 to 0.94]; P=0.03).

conclusionsMacrolide-based treatment was not associated with lower 30-day mortality among critically ill patients with pneumonia, although receipt of effective antibiotic within 4 h was strongly predictive of survival. Based on these results, timely effective treatment may be more important than choice of antibiotics.

Indexed as

Critical careIntensive careLungMacrolidesMortalityPneumonia

Identifiers

PMID24489569
PMCPMC3905010
OpenAlexW45351856

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.