Original

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-LoechesAffiliated withCritical Care Center, ParcTaulí Hospital-Sabadell Email author 
  • , J. F. Bermejo-MartinAffiliated withInfection and Immunity Unit, Hospital ClínicoUniversitario-IECSCYL
  • , J. VallésAffiliated withCritical Care Center, ParcTaulí Hospital-Sabadell
  • , R. GranadaAffiliated withCritical Care Department, Hospital de Bellvitge/CIBERES
  • , L. VidaurAffiliated withCritical Care Department, Hospital Donostia/CIBERES
  • , J. C. Vergara-SerranoAffiliated withCritical Care Department, Hospital de Cruces
  • , M. MartínAffiliated withCritical Care Department, Hospital La Candelaria
  • , J. C. FigueiraAffiliated withCritical Care Department, Hospital La Paz
  • , J. M. SirventAffiliated withCritical Care Department, Hospital Universitari Dr. Josep Trueta
    • , J. BlanquerAffiliated withCritical Care Department, Hospital ClínicoUniversitario de Valencia
    • , D. SuarezAffiliated withCritical Care Center, ParcTaulí Hospital-SabadellEpidemiology and Assessment Unit, Fundació Parc Tauli, Universitat Autònoma de Barcelona
    • , A. ArtigasAffiliated withCritical Care Center, ParcTaulí Hospital-Sabadell
    • , A. TorresAffiliated withCritical Care Center, ParcTaulí Hospital-SabadellPulmonology Department, Hospital Clínic of Barcelona, IDIBAPS, CIBERES, University of Barcelona
    • , E. DiazAffiliated withCritical Care Center, ParcTaulí Hospital-SabadellCritical Care Department, Hospital de Sant Joan Despí Moisès Broggi
    • , A. RodriguezAffiliated withCritical Care Center, ParcTaulí Hospital-SabadellCritical Care Department, Hospital Joan XXIII/CIBERES/IISPV/URV
    • , SEMICYUC/REIPI/CIBERES H1N1 Working Group

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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.

Keywords

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