Macrolide-based regimens in absence of bacterial co-infection in critically ill H1N1 patients with primary viral pneumonia

被引:37
作者
Martin-Loeches, I. [1 ]
Bermejo-Martin, J. F. [2 ]
Valles, J. [1 ]
Granada, R. [3 ]
Vidaur, L. [4 ]
Vergara-Serrano, J. C. [5 ]
Martin, M. [6 ]
Figueira, J. C. [7 ]
Sirvent, J. M. [8 ]
Blanquer, J. [9 ]
Suarez, D. [10 ]
Artigas, A. [1 ]
Torres, A. [11 ]
Diaz, E. [12 ]
Rodriguez, A. [13 ]
机构
[1] ParcTauli Hosp Sabadell, CIBERes, Crit Care Ctr, Sabadell 08208, Spain
[2] Hosp Clin Univ IECSCYL, Infect & Immun Unit, Valladolid, Spain
[3] Hosp Bellvitge CIBERES, Crit Care Dept, Barcelona, Spain
[4] Hosp Donostia CIBERES, Crit Care Dept, San Sebastian, Spain
[5] Hosp Cruces, Crit Care Dept, Bilbao, Spain
[6] Hosp La Candelaria, Crit Care Dept, Tenerife, Spain
[7] Hosp La Paz, Crit Care Dept, Madrid, Spain
[8] Hosp Univ Dr Josep Trueta, Crit Care Dept, Girona, Spain
[9] Univ Valencia, Hosp Clin, Crit Care Dept, Valencia, Spain
[10] Univ Autonoma Barcelona, Epidemiol & Assessment Unit, Fundacio Parc Tauli, Sabadell, Spain
[11] Univ Barcelona, Dept Pulmonol, Hosp Clin Barcelona, IDIBAPS,CIBERES, Barcelona, Spain
[12] Hosp St Joan Despi Moises Broggi, Crit Care Dept, St Joan Despi, Spain
[13] Hosp Joan XXIII CIBERES IISPV URV, Crit Care Dept, Tarragona, Spain
关键词
Community-acquired infection; Antimicrobial agents; Viral infections; Mechanical ventilation: clinical studies; COMMUNITY-ACQUIRED PNEUMONIA; INFLUENZA A(H1N1) INFECTION; ANTIMICROBIAL THERAPY; HOSPITALIZED-PATIENTS; RESPIRATORY-FAILURE; BETA-LACTAM; A H1N1; IMPACT; OUTCOMES; MORTALITY;
D O I
10.1007/s00134-013-2829-8
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
To determine whether macrolide-based treatment is associated with mortality in critically ill H1N1 patients with primary viral pneumonia. Secondary analysis of a prospective, observational, multicenter study conducted across 148 Intensive Care Units (ICU) in Spain. Primary viral pneumonia was present in 733 ICU patients with pandemic influenza A (H1N1) virus infection with severe respiratory failure. Macrolide-based treatment was administered to 190 (25.9 %) patients. Patients who received macrolides had chronic obstructive pulmonary disease more often, lower severity on admission (APACHE II score on ICU admission (13.1 +/- A 6.8 vs. 14.4 +/- A 7.4 points, p < 0.05), and multiple organ dysfunction syndrome less often (23.4 vs. 30.1 %, p < 0.05). Length of ICU stay in survivors was not significantly different in patients who received macrolides compared to patients who did not (10 (IQR 4-20) vs. 10 (IQR 5-20), p = 0.9). ICU mortality was 24.1 % (n = 177). Patients with macrolide-based treatment had lower ICU mortality in the univariate analysis (19.2 vs. 28.1 %, p = 0.02); however, a propensity score analysis showed no effect of macrolide-based treatment on ICU mortality (OR = 0.87; 95 % CI 0.55-1.37, p = 0.5). Moreover, the sensitivity analysis revealed very similar results (OR = 0.91; 95 % CI 0.58-1.44, p = 0.7). A separate analysis of patients under mechanical ventilation yielded similar results (OR = 0.77; 95 % CI 0.44-1.35, p = 0.4). Our results suggest that macrolide-based treatment was not associated with improved survival in critically ill H1N1 patients with primary viral pneumonia.
引用
收藏
页码:693 / 702
页数:10
相关论文
共 38 条
  • [11] Benefit of early treatment with oseltamivir in hospitalized patients with documented 2009 influenza A (H1N1): retrospective cohort study
    Hiba, Vered
    Chowers, Michal
    Levi-Vinograd, Inbal
    Rubinovitch, Bina
    Leibovici, Leonard
    Paul, Mical
    [J]. JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY, 2011, 66 (05) : 1150 - 1155
  • [12] Corticosteroid Treatment in Critically Ill Patients with Pandemic Influenza A/H1N1 2009 Infection Analytic Strategy Using Propensity Scores
    Kim, Sung-Han
    Hong, Sang-Bum
    Yun, Sung-Choel
    Choi, Won-Il
    Ahn, Jong-Joon
    Lee, Young Joo
    Lee, Heung-Bum
    Lim, Chae-Man
    Koh, Younsuck
    [J]. AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2011, 183 (09) : 1207 - 1214
  • [13] Critically Ill Patients With 2009 Influenza A(H1N1) Infection in Canada
    Kumar, Anand
    Zarychanski, Ryan
    Pinto, Ruxandra
    Cook, Deborah J.
    Marshall, John
    Lacroix, Jacques
    Stelfox, Tom
    Bagshaw, Sean
    Choong, Karen
    Lamontagne, Francois
    Turgeon, Alexis F.
    Lapinsky, Stephen
    Ahern, Stephane P.
    Smith, Orla
    Siddiqui, Faisal
    Jouvet, Philippe
    Khwaja, Kosar
    McIntyre, Lauralyn
    Menon, Kusum
    Hutchison, Jamie
    Hornstein, David
    Joffe, Ari
    Lauzier, Francois
    Singh, Jeffrey
    Karachi, Tim
    Wiebe, Kim
    Olafson, Kendiss
    Ramsey, Clare
    Sharma, Sat
    Dodek, Peter
    Meade, Maureen
    Hall, Richard
    Fowler, Robert A.
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2009, 302 (17): : 1872 - 1879
  • [14] Levy MM, 2001, INTENS CARE MED, V2003, P1250
  • [15] Factors Associated With Death or Hospitalization Due to Pandemic 2009 Influenza A(H1N1) Infection in California
    Louie, Janice K.
    Acosta, Meileen
    Winter, Kathleen
    Jean, Cynthia
    Gavali, Shilpa
    Schechter, Robert
    Vugia, Duc
    Harriman, Kathleen
    Matyas, Bela
    Glaser, Carol A.
    Samuel, Michael C.
    Rosenberg, Jon
    Talarico, John
    Hatch, Douglas
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2009, 302 (17): : 1896 - 1902
  • [16] Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults
    Mandell, Lionel A.
    Wunderink, Richard G.
    Anzueto, Antonio
    Bartlett, John G.
    Campbell, G. Douglas
    Dean, Nathan C.
    Dowell, Scott F.
    File, Thomas M., Jr.
    Musher, Daniel M.
    Niederman, Michael S.
    Torres, Antonio
    Whitney, Cynthia G.
    [J]. CLINICAL INFECTIOUS DISEASES, 2007, 44 : S27 - S72
  • [17] Use of early corticosteroid therapy on ICU admission in patients affected by severe pandemic (H1N1)v influenza A infection
    Martin-Loeches, I.
    Lisboa, T.
    Rhodes, A.
    Moreno, R. P.
    Silva, E.
    Sprung, C.
    Chiche, J. D.
    Barahona, D.
    Villabon, M.
    Balasini, C.
    Pearse, R. M.
    Matos, R.
    Rello, J.
    [J]. INTENSIVE CARE MEDICINE, 2011, 37 (02) : 272 - 283
  • [18] Combination antibiotic therapy with macrolides improves survival in intubated patients with community-acquired pneumonia
    Martin-Loeches, I.
    Lisboa, T.
    Rodriguez, A.
    Putensen, C.
    Annane, D.
    Garnacho-Montero, J.
    Restrepo, M. I.
    Rello, J.
    [J]. INTENSIVE CARE MEDICINE, 2010, 36 (04) : 612 - 620
  • [19] Community-Acquired Respiratory Coinfection in Critically III Patients With Pandemic 2009 Influenza A(H1N1) Virus
    Martin-Loeches, Ignacio
    Sanchez-Corral, Ana
    Diaz, Emili
    Maria Granada, Rosa
    Zaragoza, Rafael
    Villavicencio, Christian
    Albaya, Antonio
    Cerda, Enrique
    Maria Catalan, Rosa
    Luque, Pilar
    Paredes, Amparo
    Navarrete, Ines
    Rello, Jordi
    Rodriguez, Alejandro
    [J]. CHEST, 2011, 139 (03) : 555 - 562
  • [20] Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury
    Mehta, Ravindra L.
    Kellum, John A.
    Shah, Sudhir V.
    Molitoris, Bruce A.
    Ronco, Claudio
    Warnock, David G.
    Levin, Adeera
    [J]. CRITICAL CARE, 2007, 11 (02):