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

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.