Macrolide therapy and outcomes in a multicenter cohort of children hospitalized with Mycoplasma pneumoniae pneumonia

被引:50
作者
Shah, Samir S. [1 ,2 ,3 ]
Test, Matthew [2 ,4 ]
Sheffler-Collins, Seth [4 ]
Weiss, Anna K. [4 ]
Hall, Matthew [5 ]
机构
[1] Cincinnati Childrens Hosp, Med Ctr, Div Infect Dis, Cincinnati, OH 45229 USA
[2] Univ Cincinnati, Coll Med, Cincinnati, OH USA
[3] Cincinnati Childrens Hosp, Med Ctr, Div Hosp Med, Cincinnati, OH 45229 USA
[4] Childrens Hosp Philadelphia, Div Infect Dis, Philadelphia, PA 19104 USA
[5] Child Hlth Corp Amer, Shawnee Mission, KS USA
关键词
COMMUNITY-ACQUIRED PNEUMONIA; CHLAMYDIA-PNEUMONIAE; IN-VITRO; UREAPLASMA-UREALYTICUM; RESPIRATORY-INFECTION; EPITHELIAL-CELLS; BRONCHIAL-ASTHMA; AIRWAY DISEASE; MURINE MODEL; CLARITHROMYCIN;
D O I
10.1002/jhm.1904
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND: Mycoplasma pneumoniae is a common cause of community-acquired pneumonia in childhood. Few studies have addressed the association of antimicrobial treatment and outcomes. OBJECTIVE: To determine whether macrolide therapy is associated with improved outcomes among children hospitalized with M. pneumoniae pneumonia. DESIGN: Multicenter retrospective cohort study. SETTING: Thirty-six children's hospitals which contribute data to the Pediatric Health Information System. PATIENTS: Children 6-18 years of age discharged with a diagnosis of M. pneumoniae pneumonia. MAIN EXPOSURE: Initial macrolide therapy. MAIN OUTCOME MEASURES: Length of stay (LOS), all-cause readmissions, and asthma-related hospitalizations. RESULTS: Empiric macrolide therapy was administered to 405 (58.7%) of 690 patients. The median LOS was 3 days (interquartile range, 2-6 days). Eight (1.2 %) patients were readmitted within 28 days, and 160 (23.2%) were readmitted within 15 months of index discharge. Ninety-five (13.7%) patients were hospitalized for asthma within 15 months of index discharge. Empiric macrolide therapy was associated with a 32% shorter overall LOS (adjusted beta-coefficient, -0.38; 95% confidence interval [CI]: -0.59 to -0.17). Macrolide therapy was not associated with all-cause readmission at 28 days (adjusted odds ratio, 1.12; 95% CI: 0.22-5.78) or 15 months (adjusted odds ratio, 1.00; 95% CI: 0.59-1.70) or with asthma-related hospitalizations at 15 months (adjusted odds ratio, 0.85; 95% CI: 0.36-1.97). CONCLUSION: In this large multicenter study of children hospitalized with M. pneumoniae pneumonia, empiric macrolide therapy was associated with a shorter hospital LOS. Macrolide therapy was not associated with 28-day or 15-month hospital readmission. Journal of Hospital Medicine 2012;7:311-317 (C) 2012 Society of Hospital Medicine
引用
收藏
页码:311 / 317
页数:7
相关论文
共 58 条
[1]   Interleukin-8 gene repression by clarithromycin is mediated by the activator protein-1 binding site in human bronchial epithelial cells [J].
Abe, S ;
Nakamura, H ;
Inoue, S ;
Takeda, H ;
Saito, H ;
Kato, S ;
Mukaida, N ;
Matsushima, K ;
Tomoike, H .
AMERICAN JOURNAL OF RESPIRATORY CELL AND MOLECULAR BIOLOGY, 2000, 22 (01) :51-60
[2]   ACUTE EXACERBATIONS OF ASTHMA IN ADULTS - ROLE OF CHLAMYDIA-PNEUMONIAE INFECTION [J].
ALLEGRA, L ;
BLASI, F ;
CENTANNI, S ;
COSENTINI, R ;
DENTI, F ;
RACCANELLI, R ;
TARSIA, P ;
VALENTI, V .
EUROPEAN RESPIRATORY JOURNAL, 1994, 7 (12) :2165-2168
[3]  
[Anonymous], COCHRANE DATABASE SY
[4]  
Bamba Masahiro, 2006, Journal of Infection and Chemotherapy, V12, P36, DOI 10.1007/s10156-005-0422-y
[5]  
BERKOVICH S, 1970, ANN ALLERGY, V28, P43
[6]   Antibiotics in asthma [J].
Beuther, DA ;
Martin, RJ .
CURRENT ALLERGY AND ASTHMA REPORTS, 2004, 4 (02) :132-138
[7]   Mycoplasma pneumoniae and asthma in children [J].
Biscardi, S ;
Lorrot, M ;
Marc, E ;
Moulin, F ;
Boutonnat-Faucher, B ;
Heilbronner, C ;
Iniguez, JL ;
Chaussain, M ;
Nicand, E ;
Raymond, J ;
Gendrel, D .
CLINICAL INFECTIOUS DISEASES, 2004, 38 (10) :1341-1346
[8]   THE RISK OF DETERMINING RISK WITH MULTIVARIABLE MODELS [J].
CONCATO, J ;
FEINSTEIN, AR ;
HOLFORD, TR .
ANNALS OF INTERNAL MEDICINE, 1993, 118 (03) :201-210
[10]   Characteristics of Streptococcus pneumoniae and atypical bacterial infections in children 2-5 years of age with community-acquired pneumonia [J].
Esposito, S ;
Bosis, S ;
Cavagna, R ;
Faelli, N ;
Begliatti, E ;
Marchisio, P ;
Blasi, F ;
Bianchi, C ;
Principi, N .
CLINICAL INFECTIOUS DISEASES, 2002, 35 (11) :1345-1352