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Intensive Care Med. 2013 Apr;39(4):693-702. doi: 10.1007/s00134-013-2829-8. Epub 2013 Jan 24.

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

Collaborators (264)

Cobo P, Martins J, Carbayo C, Robles-Musso E, Cárdenas A, Fierro J, Ocaña Fernández D, Sierra R, Huertos MJ, Pozo JC, Guerrero R, Márquez E, Rodríguez-Carvajal M, Estella Á, Pomares J, Ballesteros JL, Fernández Y, Lobato F, Prieto JF, Albofedo-Sánchez J, Martínez P, de la Torre MV, Nieto M, Díaz Castellanos MA, Sevilla G, Garnacho-Montero J, Hinojosa R, Fernández E, Loza A, León C, Arenzana A, Ocaña D, Navarrete I, Zaheri Beryanaki M, Sánchez I, Avellanas ML, Lander A, de Arellano SG, Marquina Lacueva MI, Luque P, Plumed Serrano E, Lázaro JF, González I, Montón JM, Dorado Regil P, Iglesias L, Pascual González C, Quiroga, García-Rodríguez Á, Socias L, Ibánez P, Borges-Sa M, Socias A, Del Castillo A, Jordà Marcos R, Bonell JM, Amestarán I, Ruiz-Santana S, Díaz JJ, Sisón, Hernández D, Trujillo A, Regalado L, Lorente L, Martín M, Martínez S, Cáceres JJ, Suberviola B, Ugarte P, García-López F, Alonso AÁ, Pasilla A, Gómez Grande ML, Albaya A, Canabal A, Marina L, Simón A, Añón JM, López Messa JB, López Pueyo MJ, del Valle OM, Ferreras Z, Macias S, Berezo JÁ, Blanco Varela J, Andaluz Ojeda A, Álvarez Terrero A, Tena Ezpeleta F, Paez Z, García Á, Catalán RM, Ferrer M, Torres A, Cilloniz C, Barbadillo S, Cabré L, Baeza I, Rovira A, Álvarez-Lerma F, Vázquez A, Nolla J, Fernández F, Cervelló JR, Iglesia R, Mañéz R, Ballús J, Granada RM, Vallés J, Ortíz M, Guía C, Arméstar F, Páez J, Almirall J, Balanzo X, Rello J, Arnau E, Pérez M, Laborda C, Souto J, Palomar M, Catalán I, Sirvent JM, Ferri C, de Arbina NL, Badía M, Valverdú-Vidal M, Barcenilla F, Magret M, Esteban MF, Luna J, Nava JM, de Molina JG, Josic Z, Gurri F, Rodríguez P, Rodríguez A, Lisboa T, Pobo Á, Trefler S, Díaz RM, Mesalles E, de Mendoza D, Juliá-Narváez J, Fernández-Zapata A, Recio T, Arrascaeta A, García-Ramos MJ, Gallego E, Bueno F, Díaz M, Cordero ML, Pastor JA, Álvarez-Rocha L, Vila D, Díaz Lamas A, Blanco Pérez J, Ortiz Piquer M, Merayo E, López-Ciudad VJ, Cortes Cañones J, Vilaboy E, Villar Chao J, Saborido EM, González RJ, Freita S, Alemparte E, Ortega A, López AM, Canabal J, Ferres E, Monzón JL, Goñi F, Del Nogal Sáez F, Navalpotro MB, García-Torrejón MC, Pérez-Calvo C, López D, Arnaiz L, Sánchez-Alonso S, Velayos C, del Río F, González MÁ, Martín MC, Molina JM, Montejo JC, Catalán M, Albert P, de Pablo A, Guerrero JE, Zurita M, Benitez Peyrat J, Cerdá E, Alvarez M, Pey C, Rodríguez M, Palencia E, Caballero R, Vaquero C, Mariscal F, García S, Carrasco N, Prieto I, Liétor A, Ramos R, Galván B, Figueira JC, Cruz Soriano M, Galdós P, Balandin Moreno B, del Cabo F, Hermosa C, Gordo F, Algora A, Paredes A, Cambronero JA, Gómez-Rosado S, Prado López LM, Esteban A, Lorente JA, Nin N, Martínez S, Felices Abad F, Martínez M, Butí SM, Gil Rueda B, García F, Maraví-Poma E, Jimenez Urra I, Macaya L, Macaya Redin L, Tellería A, Insansti J, González N, Marco P, Vidaur L, Santamaría B, Rodríguez T, Vergara JC, Iruretagoyena Amiano JR, Manzano A, Castillo Arenal C, Olaechea PM, Martín H, Ribas A, Blanquer J, Reig Valero R, Belenger A, Altaba S, Álvarez-Sánchez B, Picos SA, Sánchez-Miralles Á, Bonastre J, Palamo M, Cebrian J, Cuñat J, Romero B, Zaragoza R, Tormo C, Paricio V, Marques A, Sánchez-Morcillo S, Tormo S, Latour J, García MÁ.

Author information

  • 1Critical Care Center, ParcTaulí Hospital-Sabadell, CIBERes, ParcTauli s/n, 08208, Sabadell, Spain. drmartinloeches@gmail.com

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.

PMID:
23344833
[PubMed - indexed for MEDLINE]
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