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Macrolide antibiotics and survival in patients with acute lung injury
Allan J Walkey1, Renda S Wiener2
1Boston University School of Medicine, The Pulmonary Center, Boston, MA.
Background:
Animal models suggest that immunomodulatory properties of macrolide antibiotics have therapeutic value for patients with acute lung injury (ALI). We investigated the association between receipt of macrolide antibiotics and clinical outcomes in patients with ALI.
Methods:
Secondary analysis of multicenter, randomized controlled trial data from the Acute Respiratory Distress Syndrome Network Lisofylline and Respiratory Management of Acute Lung Injury Trial, which collected detailed data regarding antibiotic use among participants with ALI.
Results:
Forty-seven of 235 participants (20%) received a macrolide antibiotic within 24 h of trial enrollment. Among patients who received a macrolide, erythromycin was the most common (57%), followed by azithromycin (40%). The median duration of macrolide use after study enrollment was 4 days (interquartile range, 2-8 days). Eleven of the 47 (23%) patients who received macrolides died, compared with 67 of the 188 (36%) who did not receive a macrolide (P = .11). Participants administered macrolides were more likely to have pneumonia as an ALI risk factor, were less likely to have nonpulmonary sepsis or to be randomized to low tidal volume ventilation, and had a shorter length of stay prior to trial enrollment. After adjusting for potentially confounding covariates, use of macrolide was associated with lower 180-day mortality (hazard ratio [HR], 0.46; 95% CI, 0.23-0.92; P = .028) and shorter time to successful discontinuation of mechanical ventilation (HR, 1.93; 95% CI, 1.18-3.17; P = .009). In contrast, fluoroquinolone (n = 90) and cephalosporin antibiotics (n = 93) were not associated with improved outcomes.
Conclusions:
Receipt of macrolide antibiotics was associated with improved outcomes in patients with ALI.
Insights
Macrolide antibiotics may improve outcomes for patients with acute lung injury (ALI). This study found macrolide use was linked to lower mortality and faster mechanical ventilation weaning in ALI patients.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Pharmacology
Background:
- Animal models suggest immunomodulatory effects of macrolide antibiotics offer therapeutic potential for acute lung injury (ALI).
- Clinical evidence is needed to confirm macrolide benefits in ALI patients.
Purpose of the Study:
- To investigate the association between macrolide antibiotic use and clinical outcomes in patients diagnosed with ALI.
- To determine if macrolides impact mortality and mechanical ventilation duration in ALI.
Main Methods:
- Secondary analysis of data from a multicenter, randomized controlled trial (Acute Respiratory Distress Syndrome Network Trial).
- Detailed antibiotic use data was collected for participants with ALI.
- Statistical analysis adjusted for potential confounding factors.
Main Results:
- Macrolide antibiotics were administered to 20% of ALI participants within 24 hours of enrollment.
- Macrolide use was associated with a significant reduction in 180-day mortality (HR, 0.46; P = .028).
- Macrolide administration correlated with a shorter time to successful mechanical ventilation discontinuation (HR, 1.93; P = .009).
Conclusions:
- Receipt of macrolide antibiotics is associated with improved clinical outcomes in patients with acute lung injury.
- Macrolides demonstrate potential as a therapeutic option for managing ALI.
- Fluoroquinolone and cephalosporin antibiotics did not show similar outcome improvements.
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