Intensive Care Medicine

, Volume 39, Issue 4, pp 693–702

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
  • SEMICYUC/REIPI/CIBERES H1N1 Working Group
Original

DOI: 10.1007/s00134-013-2829-8

Cite this article as:
Martín-Loeches, I., Bermejo-Martin, J.F., Vallés, J. et al. Intensive Care Med (2013) 39: 693. doi:10.1007/s00134-013-2829-8

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.

Keywords

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

Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2013

Authors and Affiliations

  • I. Martín-Loeches
    • 1
  • J. F. Bermejo-Martin
    • 2
  • J. Vallés
    • 1
  • R. Granada
    • 3
  • L. Vidaur
    • 4
  • J. C. Vergara-Serrano
    • 5
  • M. Martín
    • 6
  • J. C. Figueira
    • 7
  • J. M. Sirvent
    • 8
  • J. Blanquer
    • 9
  • D. Suarez
    • 10
  • A. Artigas
    • 1
  • A. Torres
    • 11
  • E. Diaz
    • 12
  • A. Rodriguez
    • 13
  • SEMICYUC/REIPI/CIBERES H1N1 Working Group
  1. 1.Critical Care CenterParcTaulí Hospital-SabadellSabadellSpain
  2. 2.Infection and Immunity UnitHospital ClínicoUniversitario-IECSCYLValladolidSpain
  3. 3.Critical Care DepartmentHospital de Bellvitge/CIBERESBarcelonaSpain
  4. 4.Critical Care DepartmentHospital Donostia/CIBERESSan SebastianSpain
  5. 5.Critical Care DepartmentHospital de CrucesBilbaoSpain
  6. 6.Critical Care DepartmentHospital La CandelariaTenerifeSpain
  7. 7.Critical Care DepartmentHospital La PazMadridSpain
  8. 8.Critical Care DepartmentHospital Universitari Dr. Josep TruetaGironaSpain
  9. 9.Critical Care DepartmentHospital ClínicoUniversitario de ValenciaValenciaSpain
  10. 10.Epidemiology and Assessment Unit, Fundació Parc TauliUniversitat Autònoma de BarcelonaSabadellSpain
  11. 11.Pulmonology Department, Hospital Clínic of Barcelona, IDIBAPS, CIBERESUniversity of BarcelonaBarcelonaSpain
  12. 12.Critical Care DepartmentHospital de Sant Joan Despí Moisès BroggiSant Joan DespíSpain
  13. 13.Critical Care DepartmentHospital Joan XXIII/CIBERES/IISPV/URVTarragonaSpain