Macrolides in critically ill patients with Middle East Respiratory Syndrome
Autor: | Jesna Jose, Ahmed Abdulmomen, Ahmed Mady, Sarah Shalhoub, Ahmad Ragab, Ismael Qushmaq, Yaseen M. Arabi, Ahmad M. Deeb, Laura Merson, Abdullah Almotairi, Tarek Al Dabbagh, Awad Al-Omari, Kasim Al Khatib, Othman Solaiman, Ghaleb A. Almekhlafi, Abdulrahman Al Harthy, Yasser Mandourah, Rajaa Al-Raddadi, Ayman Kharaba, Abdulsalam M. Al-Aithan, Hanan H. Balkhy, Anees Sindi, Frederick G. Hayden, Fahad Al-Hameed, Robert A. Fowler, Basem Alraddadi |
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Jazyk: | angličtina |
Rok vydání: | 2019 |
Předmět: |
0301 basic medicine
Male viruses Azithromycin medicine.disease_cause law.invention MERS-CoV 0302 clinical medicine law Medicine 030212 general & internal medicine virus diseases General Medicine respiratory system Middle Aged Intensive care unit Anti-Bacterial Agents Intensive Care Units Infectious Diseases Viral pneumonia Cohort Middle East Respiratory Syndrome Coronavirus Female Macrolides Coronavirus Infections medicine.drug Microbiology (medical) Adult medicine.medical_specialty Middle East respiratory syndrome coronavirus Critical Illness 030106 microbiology Saudi Arabia Article lcsh:Infectious and parasitic diseases 03 medical and health sciences Internal medicine Humans lcsh:RC109-216 Aged Retrospective Studies business.industry Odds ratio Pneumonia biochemical phenomena metabolism and nutrition medicine.disease Influenza respiratory tract diseases Critical care Middle East respiratory syndrome business |
Zdroj: | International Journal of Infectious Diseases International Journal of Infectious Diseases, Vol 81, Iss, Pp 184-190 (2019) |
Popis: | Highlights • More than one-third of critically ill patients with Middle East Respiratory Syndrome Coronavirus (MERS-CoV) received empiric therapy with macrolides. • Macrolide therapy is not significantly associated with a reduction in 90-day mortality of critically ill patients with MERS-CoV. • Macrolide therapy is not significantly associated with improvement in MERS-CoV RNA clearance of critically ill patients with MERS-CoV. Objectives Macrolides have been reported to be associated with improved outcomes in patients with viral pneumonia related to influenza and other viruses, possibly because of their immune-modulatory effects. Macrolides have frequently been used in patients with Middle East Respiratory Syndrome (MERS). This study investigated the association of macrolides with 90-day mortality and MERS coronavirus (CoV) RNA clearance in critically ill patients with MERS. Methods This retrospective analysis of a multicenter cohort database included 14 tertiary-care hospitals in five cities in Saudi Arabia. Multivariate logistic-regression analysis was used to determine the association of macrolide therapy with 90-day mortality, and the Cox-proportional hazard model to determine the association of macrolide therapy with MERS-CoV RNA clearance. Results Of 349 critically ill MERS patients, 136 (39%) received macrolide therapy. Azithromycin was most commonly used (97/136; 71.3%). Macrolide therapy was commonly started before the patient arrived in the intensive care unit (ICU) (51/136; 37.5%), or on day1 in ICU (53/136; 39%). On admission to ICU, the baseline characteristics of patients who received and did not receive macrolides were similar, including demographic data and sequential organ failure assessment score. However, patients who received macrolides were more likely to be admitted with community-acquired MERS (P = 0.02). Macrolide therapy was not independently associated with a significant difference in 90-day mortality (adjusted odds ratio [OR]: 0.84; 95% confidence interval [CI] :0.47–1.51; P = 0.56) or MERS-CoV RNA clearance (adjusted HR: 0.88; 95% CI:0.47–1.64; P = 0.68). Conclusions These findings indicate that macrolide therapy is not associated with a reduction in 90-day mortality or improvement in MERS-CoV RNA clearance. |
Databáze: | OpenAIRE |
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