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

I. Martín-Loeches, J. F. Bermejo-Martin, J. Vallés, R. Granada, L. Vidaur, J. C. Vergara-Serrano, M. Martín, J. C. Figueira, J. M. Sirvent, J. Blanquer, D. Suarez, A. Artigas, A. Torres, E. Diaz, A. Rodriguez

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Abstract

Purpose: To determine whether macrolide-based treatment is associated with mortality in critically ill H1N1 patients with primary viral pneumonia. Methods: Secondary analysis of a prospective, observational, multicenter study conducted across 148 Intensive Care Units (ICU) in Spain. Results: 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 ± 6.8 vs. 14.4 ± 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). Conclusion: Our results suggest that macrolide-based treatment was not associated with improved survival in critically ill H1N1 patients with primary viral pneumonia. © 2013 Springer-Verlag Berlin Heidelberg and ESICM.
Original languageEnglish
Pages (from-to)693-702
JournalIntensive Care Medicine
Volume39
Issue number4
DOIs
Publication statusPublished - 1 Apr 2013

Keywords

  • Antimicrobial agents
  • Community-acquired infection
  • Mechanical ventilation: clinical studies
  • Viral infections

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    Martín-Loeches, I., Bermejo-Martin, J. F., Vallés, J., Granada, R., Vidaur, L., Vergara-Serrano, J. C., Martín, M., Figueira, J. C., Sirvent, J. M., Blanquer, J., Suarez, D., Artigas, A., Torres, A., Diaz, E., & Rodriguez, A. (2013). Macrolide-based regimens in absence of bacterial co-infection in critically ill H1N1 patients with primary viral pneumonia. Intensive Care Medicine, 39(4), 693-702. https://doi.org/10.1007/s00134-013-2829-8