Association of azithromycin with mortality and cardiovascular events among older patients hospitalized with pneumonia.
Association of azithromycin with mortality and cardiovascular events among older patients hospitalized with pneumonia.
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DOI：
10.1001/jama.2014.4304
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发表时间：
2014-06-04
影响因子：
120.7
通讯作者：
Anzueto, Antonio
中科院分区：
文献类型：
--
作者：
Mortensen, Eric M.;Halm, Ethan A.;Pugh, Mary Jo;Copeland, Laurel A.;Metersky, Mark;Fine, Michael J.;Johnson, Christopher S.;Alvarez, Carlos A.;Frei, Christopher R.;Good, Chester;Restrepo, Marcos I.;Downs, John R.;Anzueto, Antonio
尽管临床实践指南建议将包括阿奇霉素在内的大环内酯类药物联合治疗作为肺炎住院患者的一线治疗，但最近的研究表明阿奇霉素可能与心血管事件增加相关。本研究的目的是检查阿奇霉素的使用与肺炎住院患者的全因死亡率和心血管事件之间的关系。回顾性队列研究，比较2002-2012财政年度期间因肺炎住院的老年患者接受阿奇霉素治疗和接受其他指南一致性抗生素治疗的患者。本研究使用国家退伍军人事务部管理数据进行，这些数据来自在退伍军人管理局急性护理医院住院的患者。如果患者年龄≥65岁，因肺炎住院，并接受了符合国家临床实践指南的抗生素治疗，则纳入患者。结果包括30天和90天的全因死亡率，以及90天的心律失常、心力衰竭、心肌梗死和任何心脏事件。倾向评分匹配用于控制已知混杂因素与条件logistic回归的可能影响。在来自118家医院的73，690名患者中，倾向匹配组由31，863名阿奇霉素暴露者和31，863名匹配的未暴露者组成。配对后，两组之间的潜在混杂因素无显著差异。90-接受阿奇霉素治疗的患者的日死亡率显着降低（暴露组-17.4% vs未暴露组-22.3%，比值比[OR] 0.73，95%置信区间[CI] 0.70-0.76）。然而，我们发现，（5.1% vs. 4.4%，OR 1.17，95% CI 1.08-1.25），但无任何心脏事件（43.0% vs. 42.7%，OR 1.01，95% CI 0.98-1.05），心律失常（25.8% vs. 26.0%，OR 0.99，95% CI 0.95-1.02）或心力衰竭（26.3% vs. 26.2%，OR 1.01，95% CI 0.97-1.04）。在因肺炎住院的老年患者中，与其他抗生素相比，阿奇霉素治疗与90天死亡率降低和心肌梗死风险增加较小相关。这些发现与阿奇霉素使用相关的净获益一致。
Although clinical practice guidelines recommend combination therapy with macrolides, including azithromycin, as first line therapy for patients hospitalized with pneumonia, recent research suggests that azithromycin may be associated with increased cardiovascular events. The purpose of this study was to examine the association of azithromycin use with all-cause mortality and cardiovascular events for patients hospitalized with pneumonia. Retrospective, cohort study comparing older patients hospitalized with pneumonia between fiscal years 2002–2012 prescribed azithromycin therapy and patients receiving other guideline-concordant antibiotic therapy This study was conducted using national Department of Veterans Affairs administrative data of patients hospitalized at any Veterans Administration acute care hospital. Patients were included if they were ≥65 years of age hospitalized with pneumonia and received antibiotic therapy concordant with national clinical practice guidelines. Outcomes included 30 and 90-day all-cause mortality, and 90-day cardiac arrhythmias, heart failure, myocardial infarction, and any cardiac event. Propensity score matching was used to control for the possible effects of known confounders with conditional logistic regression. Out of the 73,690 patients from 118 hospitals identified, propensity-matched groups were composed of 31,863 azithromycin-exposed and 31,863 matched unexposed. There were no significant differences in potential confounders between groups after matching. 90-day mortality was significantly lower in those who received azithromycin (exposed- 17.4% vs. unexposed- 22.3%, odds ratio [OR] 0.73, 95% confidence interval [CI] 0.70–0.76). However, we found significant increased odds of myocardial infarctions (5.1% vs. 4.4%, OR 1.17, 95% CI 1.08–1.25) but not any cardiac event (43.0% vs. 42.7%, OR 1.01, 95% CI 0.98–1.05), cardiac arrhythmias (25.8% vs. 26.0%, OR 0.99, 95% CI 0.95–1.02), or heart failure (26.3% vs. 26.2%, OR 1.01, 95% CI 0.97–1.04). Among older patients hospitalized with pneumonia, treatment that included azithromycin compared with other antibiotics was associated with a lower risk of 90-day mortality and a smaller increased risk of myocardial infarctions. These findings are consistent with a net benefit associated with azithromycin use.
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影响因子：
7.2
作者：
DEYO, RA;CHERKIN, DC;CIOL, MA
通讯作者：
CIOL, MA
影响因子：
120.7
作者：
O'Connor, CM;Dunne, MW;Cook, TD
通讯作者：
Cook, TD
DOI：
10.1111/j.1540-8159.2007.00912.x
发表时间：
2007-12-01
影响因子：
1.8
作者：
Huang, Bien-Hsien;Wu, Chi-Hua;Chen, Chung Yin
通讯作者：
Chen, Chung Yin
影响因子：
15.1
作者：
Mortensen, Eric M.;Restrepo, Marcos I.;Pugh, Jacqueline
通讯作者：
Pugh, Jacqueline
影响因子：
9.6
作者：
Meterky, Mark L.;Ma, Allen;Bratzler, Dale W.
通讯作者：
Bratzler, Dale W.