Macrolides in critically ill patients with Middle East Respiratory Syndrome

被引：88

作者：

Arabi, Yaseen M. ^{[1
,2
]}

Deeb, Ahmad M. ^{[3
]}

Al-Hameed, Fahad ^{[4
,5
]}

Mandourah, Yasser ^{[6
]}

Almekhlafi, Ghaleb A. ^{[6
]}

Sindi, Anees A. ^{[7
]}

Al-Omari, Awad ^{[8
,9
]}

Shalhoub, Sarah ^{[10
,30
]}

Mady, Ahmed ^{[11
,12
]}

Alraddadi, Basem ^{[8
,13
]}

Almotairi, Abdullah ^{[14
]}

Al Khatib, Kasim ^{[15
]}

Abdulmomen, Ahmed ^{[16
]}

Qushmaq, Ismael ^{[13
]}

Solaiman, Othman ^{[17
]}

Al-Aithan, Abdulsalam M. ^{[18
,31
]}

Al-Raddadi, Rajaa ^{[19
]}

Ragab, Ahmad ^{[20
]}

Al Harthy, Abdulrahman ^{[11
]}

Kharaba, Ayman ^{[21
]}

Jose, Jesna ^{[22
]}

Dabbagh, Tarek ^{[2
,23
]}

Fowler, Robert A. ^{[24
,25
,26
]}

Balkhy, Hanan H. ^{[1
,27
]}

Merson, Laura ^{[1
,28
]}

Hayden, Frederick G. ^{[29
]}

机构：

[1] King Saud bin Abdulaziz Univ Hlth Sci, King Abdullah Int Med Res Ctr, Coll Med, Riyadh, Saudi Arabia

[2] Minist Natl Guard Hlth Affairs, Dept Intens Care, Riyadh, Saudi Arabia

[3] King Saud bin Abdulaziz Univ Hlth Sci, King Abdullah Int Med Res Ctr, Res Off, Minist Natl Guard Hlth Affairs, Riyadh, Saudi Arabia

[4] King Saud bin Abdulaziz Univ Hlth Sci, King Abdullah Int Med Res Ctr, Coll Med, Jeddah, Saudi Arabia

[5] Minist Natl Guard Hlth Affairs, Dept Intens Care, Jeddah, Saudi Arabia

[6] Prince Sultan Mil Med City, Dept Intens Care Serv, Riyadh, Saudi Arabia

[7] King Abdulaziz Univ, Fac Med, Dept Anesthesia & Crit Care, Jeddah, Saudi Arabia

[8] Alfaisal Univ, Coll Med, Riyadh, Saudi Arabia

[9] Dr Sulaiman Al Habib Grp Hosp, Dept Intens Care, Riyadh, Saudi Arabia

[10] King Fahad Armed Forces Hosp, Dept Med, Div Infect Dis, Jeddah, Saudi Arabia

[11] King Saud Med City, Dept Intens Care, Riyadh, Saudi Arabia

[12] Tanta Univ Hosp, Dept Anesthesiol & Intens Care, Tanta, Egypt

[13] King Faisal Specialist Hosp & Res Ctr, Dept Med, Jeddah, Saudi Arabia

[14] King Fahad Med City, Dept Crit Care Med, Riyadh, Saudi Arabia

[15] Al Noor Specialist Hosp, Dept Intens Care, Mecca, Saudi Arabia

[16] King Saud Univ, Dept Crit Care Med, Riyadh, Saudi Arabia

[17] King Faisal Specialist Hosp & Res Ctr, Riyadh, Saudi Arabia

[18] Minist Natl Guard Hlth Affairs, Dept Intens Care, Al Hasa, Saudi Arabia

[19] King Abdulaziz Univ, Dept Family & Community Med, Jeddah, Saudi Arabia

[20] King Fahad Cent Hosp, Dept Intens Care, Jeddah, Saudi Arabia

[21] Ohoud Hosp, King Fahad Hosp, Dept Crit Care, Al Madinah Al Monawarah, Saudi Arabia

[22] King Saud bin Abdulaziz Univ Hlth Sci, King Abdullah Int Med Res Ctr, Minist Natl Guard Hlth Affairs, Dept Biostat & Bioinformat, Riyadh, Saudi Arabia

[23] King Saud bin Abdulaziz Univ Hlth Sci, King Abdullah Int Med Res Ctr, POB 22490, Riyadh 11426, Saudi Arabia

[24] Univ Toronto, Inst Hlth Policy Management & Evaluat, Toronto, ON, Canada

[25] Sunnybrook Med Ctr, Dept Crit Care Med, Toronto, ON, Canada

[26] Sunnybrook Med Ctr, Dept Med, Toronto, ON, Canada

[27] Minist Natl Guard Hlth Affairs, Dept Infect Prevent & Control, Riyadh, Saudi Arabia

[28] Univ Oxford, Infect Dis Data Observ, Int Severe Acute Resp & Emerging Infect Consortiu, Oxford, England

[29] Univ Virginia, Sch Med, Dept Med, Int Severe Acute Resp & Emerging Infect Consortiu, Charlottesville, VA 22908 USA

[30] Univ Western Ontario, Dept Med, Div Infect Dis, London, ON, Canada

[31] King Saud bin Abdulaziz Univ Hlth Sci, King Abdullah Int Med Res Ctr, Al Hasa, Saudi Arabia

来源：

INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES | 2019年 / 81卷

关键词：

Macrolides; MERS-CoV; Critical care; Pneumonia; Influenza; Azithromycin; HOSPITALIZED INFANTS; AZITHROMYCIN; CLARITHROMYCIN; INFECTION; BRONCHIOLITIS; MULTICENTER; THERAPY; DISEASE;

D O I：

10.1016/j.ijid.2019.01.041

中图分类号：

R51 [传染病];

学科分类号：

100401 ;

摘要：

Objectives: Macrolides have been reported to be associated with improved outcomes in patients with viral pneumonia related to influenza and other viruses, possibly because of their immune-modulatory effects. Macrolides have frequently been used in patients with Middle East Respiratory Syndrome (MERS). This study investigated the association of macrolides with 90-day mortality and MERS coronavirus (CoV) RNA clearance in critically ill patients with MERS. Methods: This retrospective analysis of a multicenter cohort database included 14 tertiary-care hospitals in five cities in Saudi Arabia. Multivariate logistic-regression analysis was used to determine the association of macrolide therapy with 90-day mortality, and the Cox-proportional hazard model to determine the association of macrolide therapy with MERS-CoV RNA clearance. Results: Of 349 critically ill MERS patients, 136 (39%) received macrolide therapy. Azithromycin was most commonly used (97/136; 71.3%). Macrolide therapy was commonly started before the patient arrived in the intensive care unit (ICU) (51/136; 37.5%), or on day1 in ICU (53/136; 39%). On admission to ICU, the baseline characteristics of patients who received and did not receive macrolides were similar, including demographic data and sequential organ failure assessment score. However, patients who received macrolides were more likely to be admitted with community-acquired MERS (P = 0.02). Macrolide therapy was not independently associated with a significant difference in 90-day mortality (adjusted odds ratio [OR]: 0.84; 95% confidence interval [CI] : 0.47-1.51; P = 0.56) or MERS-CoV RNA clearance (adjusted HR: 0.88; 95% CI: 0.47-1.64; P = 0.68). Conclusions: These findings indicate that macrolide therapy is not associated with a reduction in 90-day mortality or improvement in MERS-CoV RNA clearance. (C) 2019 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.

引用

页码：184 / 190

页数：7

共 33 条

[11] Mechanisms of Action and Clinical Application of Macrolides as Immunomodulatory Medications
Kanoh, Soichiro
Rubin, Bruce K.
[J]. CLINICAL MICROBIOLOGY REVIEWS, 2010, 23 (03) : 590 - +
[12] Azithromycin does not improve disease course in hospitalized infants with respiratory syncytial virus (RSV) lower respiratory tract disease: A randomized equivalence trial
Kneyber, Martin C. J.
van Woensel, Job B. M.
Uijtendaal, Esther
Uiterwaal, Cuno S. P. M.
Kimpen, Jan L. L.
[J]. PEDIATRIC PULMONOLOGY, 2008, 43 (02) : 142 - 149
[13] Anti-inflammatory effects of adjunctive macrolide treatment in adults hospitalized with influenza: A randomized controlled trial
Lee, Nelson
Wong, Chun-Kwok
Chan, Martin C. W.
Yeung, Esther S. L.
Tam, Wilson W. S.
Tsang, Owen T. Y.
Choi, Kin-Wing
Chan, Paul K. S.
Kwok, Angela
Lui, Grace C. Y.
Leung, Wai-Shing
Yung, Irene M. H.
Wong, Rity Y. K.
Cheung, Catherine S. K.
Hui, David S. C.
[J]. ANTIVIRAL RESEARCH, 2017, 144 : 48 - 56
[14] Azithromycin decreases NALP3 mRNA stability in monocytes to limit inflammasome-dependent inflammation
Lendermon, Elizabeth A.
Coon, Tiffany A.
Bednash, Joseph S.
Weathington, Nathaniel M.
McDyer, John F.
Mallampalli, Rama K.
[J]. RESPIRATORY RESEARCH, 2017, 18
[15] Macrolide-based regimens in absence of bacterial co-infection in critically ill H1N1 patients with primary viral pneumonia
Martin-Loeches, I.
Bermejo-Martin, J. F.
Valles, J.
Granada, R.
Vidaur, L.
Vergara-Serrano, J. C.
Martin, M.
Figueira, J. C.
Sirvent, J. M.
Blanquer, J.
Suarez, D.
Artigas, A.
Torres, A.
Diaz, E.
Rodriguez, A.
[J]. INTENSIVE CARE MEDICINE, 2013, 39 (04) : 693 - 702
[16] McCallum G, 2013, PLOS ONE, V8, P9
[17] Macrolide Therapy in Respiratory Viral Infections
Min, Jin-Young
Jang, Yong Ju
[J]. MEDIATORS OF INFLAMMATION, 2012, 2012
[18] Functional and immune response to respiratory syncytial virus infection in aged BALB/c mice: A search for genes determining disease severity
Mosquera, Ricardo A.
Stark, James M.
Atkins, Constance L.
Colasurdo, Guiseppe N.
Chevalier, Justyna
Samuels, Cheryl L.
Pacheco, Susan S.
[J]. EXPERIMENTAL LUNG RESEARCH, 2014, 40 (01) : 40 - 49
[19] Nakamura H, 1999, EUR RESPIR J, V13, P1371, DOI 10.1034/j.1399-3003.1999.13f23.x
[20] NIH, 2017, MACROLIDE ANTIBIOTIC

← 1 2 3 4 →