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


CONCLUSIONS
Our results suggest that macrolide-based treatment was not associated with improved survival in critically ill H1N1 patients with primary viral pneumonia.
Critical Care Center, ParcTaulí Hospital-Sabadell, CIBERes, ParcTauli s/n, 08208, Sabadell, Spain. drmartinloeches@gmail.com
I
I
Martín-Loeches
J F
JF
Bermejo-Martin
J
J
Vallés
R
R
Granada
L
L
Vidaur
J C
JC
Vergara-Serrano
M
M
Martín
J C
JC
Figueira
J M
JM
Sirvent
J
J
Blanquer
D
D
Suarez
A
A
Artigas
A
A
Torres
E
E
Diaz
A
A
Rodriguez
D018806:APACHE; D000328:Adult; D060085:Coinfection; D015897:Comorbidity; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay; D018942:Macrolides / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D011024:Pneumonia, Viral / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy; D057216:Propensity Score; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000188:drug therapy / Q000209:etiology / Q000401:mortality; D013030:Spain / Q000453:epidemiology; D016896:Treatment Outcome
D018942:Macrolides