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
  • [31] Impact of intravenous β-lactam/macrolide versus β-lactam monotherapy on mortality in hospitalized patients with community-acquired pneumonia
    Tessmer, A.
    Welte, T.
    Martus, P.
    Schnoor, M.
    Marre, R.
    Suttorp, N.
    [J]. JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY, 2009, 63 (05) : 1025 - 1033
  • [32] Delayed Clearance of Viral Load and Marked Cytokine Activation in Severe Cases of Pandemic H1N1 2009 Influenza Virus Infection
    To, Kelvin K. W.
    Hung, Ivan F. N.
    Li, Iris W. S.
    Lee, Kar-Lung
    Koo, Chi-Kwan
    Yan, Wing-Wa
    Liu, Raymond
    Ho, Ka-Ying
    Chu, Kwok-Hong
    Watt, Chi-Leung
    Luk, Wei-Kwang
    Lai, Kang-Yiu
    Chow, Fu-Loi
    Mok, Thomas
    Buckley, Tom
    Chan, Jasper F. W.
    Wong, Samson S. Y.
    Zheng, Bojian
    Chen, Honglin
    Lau, Candy C. Y.
    Tse, Herman
    Cheng, Vincent C. C.
    Chan, Kwok-Hung
    Yuen, Kwok-Yung
    [J]. CLINICAL INFECTIOUS DISEASES, 2010, 50 (06) : 850 - 859
  • [33] Macrolides inhibit IL17-induced IL8 and 8-isoprostane release from human airway smooth muscle cells
    Vanaudenaerde, B. M.
    Wuyts, W. A.
    Geudens, N.
    Dupont, L. J.
    Schoofs, K.
    Smeets, S.
    Van Raemdonck, D. E.
    Verleden, G. M.
    [J]. AMERICAN JOURNAL OF TRANSPLANTATION, 2007, 7 (01) : 76 - 82
  • [34] Effect of immunomodulatory therapies in patients with pandemic influenza A (H1N1) 2009 complicated by pneumonia
    Viasus, Diego
    Ramon Pano-Pardo, Jose
    Cordero, Elisa
    Campins, Antoni
    Lopez-Medrano, Francisco
    Villoslada, Aroa
    Farinas, Maria C.
    Moreno, Asuncion
    Rodriguez-Bano, Jesus
    Antonio Oteo, Jose
    Martinez-Montauti, Joaquin
    Torre-Cisneros, Julian
    Segura, Ferran
    Carratala, Jordi
    [J]. JOURNAL OF INFECTION, 2011, 62 (03) : 193 - 199
  • [35] Monotherapy may be suboptimal for severe bacteremic pneumococcal pneumonia
    Waterer, GW
    Somes, GW
    Wunderink, RG
    [J]. ARCHIVES OF INTERNAL MEDICINE, 2001, 161 (15) : 1837 - 1842
  • [36] Critical Care Services and 2009 H1N1 Influenza in Australia and New Zealand.
    Webb, Steven A. R.
    Pettila, Ville
    Seppelt, Ian
    Bellomo, Rinaldo
    Bailey, Michael
    Cooper, David J.
    Cretikos, Michelle
    Davies, Andrew R.
    Finfer, Simon
    Harrigan, Peter W. J.
    Hart, Graeme K.
    Howe, Belinda
    Iredell, Jonathan R.
    McArthur, Colin
    Mitchell, Imogen
    Morrison, Siouxzy
    Nichol, Alistair D.
    Paterson, David L.
    Peake, Sandra
    Richards, Brent
    Stephens, Dianne
    Turner, Andrew
    Yung, Michael
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 2009, 361 (20) : 1925 - 1934
  • [37] THE VALUE OF ROUTINE MICROBIAL INVESTIGATION IN COMMUNITY-ACQUIRED PNEUMONIA
    WOODHEAD, MA
    ARROWSMITH, J
    CHAMBERLAINWEBBER, R
    WOODING, S
    WILLIAMS, I
    [J]. RESPIRATORY MEDICINE, 1991, 85 (04) : 313 - 317
  • [38] Adjunctive Therapy in Community-Acquired Pneumonia
    Wunderink, Richard G.
    Mandell, Lionel
    [J]. SEMINARS IN RESPIRATORY AND CRITICAL CARE MEDICINE, 2012, 33 (03) : 311 - 318