Abstract

Macrolides are known for their antibacterial activity as well as immunomodulatory properties, which may be beneficial in critically ill patients. This study aimed to evaluate the impact of macrolide use on early and six-month mortality in patients treated in the intensive care unit (ICU) for community-acquired pneumonia (CAP). This retrospective study included adults hospitalized in the pulmonary ICU between 2016 and 2024 with a diagnosis of CAP. Demographic, clinical, and laboratory data were collected, along with information on nursing home residence, bed dependency, immunosuppression, and hospital stay duration. Patients were grouped by macrolide use and compared in terms of ICU and 6-month mortality. Among 334 patients included, 35.3% received macrolides. No significant differences were found between the macrolide and non-macrolide groups in terms of age, sex, comorbidities, inflammatory markers, CURB-65 scores, ventilation needs, or ICU mortality. However, six-month mortality was significantly lower in the macrolide group (18.6% vs. 28.6%, p=0.027). Patients in this group also had a shorter duration of empirical antibiotic use (6 days vs. 7 days, p = 0.04) and were less likely to be bedridden (18.6% vs. 31.9%, p = 0.009). Macrolide use appears to have no impact on short-term ICU mortality but may improve long-term survival by reducing 6-month mortality, likely through anti-inflammatory and immunomodulatory effects. While previous studies support their role in suppressing proinflammatory cytokines, further research is needed to determine whether this benefit stems from patient selection or the drug’s direct effects.

Key words: Community-acquired pneumonia, Macrolides, Intensive Care Unit, Mortality