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
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
Externí odkaz: