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Publication Details

Title :

Macrolides in critically ill patients with Middle East Respiratory Syndrome

Journal:

Int J Infect Dis.

Impact Factor:

3.202

Authors:

Arabi YM1, Deeb AM2, Al-Hameed F3, Mandourah Y4, Almekhlafi GA5, Sindi AA6, Al-Omari A7, Shalhoub S8, Mady A9, Alraddadi B10, Almotairi A11, Al Khatib K12, Abdulmomen A13, Qushmaq I14, Solaiman O15, Al-Aithan AM16, Al-Raddadi R17, Ragab A18, Al Harthy A19, Kharaba A20, Jose J21, Dabbagh T22, Fowler RA23, Balkhy HH24, Merson L25, Hayden FG26; Saudi Critical Care Trials group.

Affiliations:

1 College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Intensive Care Department, Ministry of the National Guard – Health Affairs, Riyadh, Saudi Arabia. Electronic address: arabi@ngha.med.sa.

2 Research Office, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Ministry of the National Guard – Health Affairs, Riyadh, Saudi Arabia. Electronic address: rn_a_deeb@hotmail.com.

3 College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Jeddah, Saudi Arabia; Department of Intensive Care, Ministry of the National Guard – Health Affairs, Jeddah, Saudi Arabia. Electronic address: Hameedf@ngha.med.sa.

4 Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, Saudi Arabia. Electronic address: Yasser.mandourah@me.com.

5 Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, Saudi Arabia. Electronic address: gmekhlafi@yahoo.com.

6 Department of Anesthesia and Critical Care, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia. Electronic address: ansindi@gmail.com.

7 College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; Department of Intensive Care, Dr Sulaiman Al-Habib Group Hospitals, Riyadh, Saudi Arabia. Electronic address: dr_awad_ksa@yahoo.com.

8 Department of Medicine, Division of Infectious Diseases, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia; Department of Medicine, Division of Infectious Diseases, University of Western Ontario, London, Canada. Electronic address: sarah.shalhoub@googlemail.com.

9 Intensive Care Department, King Saud Medical City, Riyadh, Saudi Arabia; Department of Anesthesiology and Intensive Care, Tanta University Hospitals, Tanta, Egypt. Electronic address: afmady@hotmail.com.

10 College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia. Electronic address: basemalraddadi@gmail.com.

11 Department of Critical Care Medicine, King Fahad Medical City, Riyadh, Saudi Arabia. Electronic address: aalmotairi@kfmc.med.sa.

12 Intensive Care Department, Al-Noor Specialist Hospital, Makkah, Saudi Arabia. Electronic address: kasimalkhatib@yahoo.com.

13 Department of Critical Care Medicine, King Saud University, Riyadh, Saudi Arabia. Electronic address: aturk@ksu.edu.sa.

14 Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia. Electronic address: iqushmaq@kfshrc.edu.sa.

15 King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. Electronic address: omsmd@yahoo.com.

16 Intensive Care Department, Ministry of the National Guard – Health Affairs, Al Ahsa, Saudi Arabia; King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Al Ahsa, Saudi Arabia. Electronic address: AithanA@ngha.med.sa.

17 King Abdulaziz University, Department of Family and Community Medicine, Jeddah, Saudi Arabia. Electronic address: saudiresearcher@yahoo.com.

18 Intensive Care Department, King Fahd Hospital, Jeddah, Saudi Arabia. Electronic address: ahmadragab63@hotmail.com.

19 Intensive Care Department, King Saud Medical City, Riyadh, Saudi Arabia. Electronic address: a_almshal@hotmail.com.

20 Department of Critical Care, King Fahad Hospital, Ohoud Hospital, Al-Madinah Al-Monawarah, Saudi Arabia. Electronic address: a7yman@hotmail.com.

21 Department of Biostatistics and Bioinformatics, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Ministry of the National Guard – Health Affairs, Riyadh, Saudi Arabia. Electronic address: joseje@ngha.med.sa.

22 Intensive Care Department, Ministry of the National Guard – Health Affairs, Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. Electronic address: DabbaghT@ngha.med.sa.

23 Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Critical Care Medicine and Department of Medicine, Sunnybrook Hospital, Toronto, Ontario, Canada. Electronic address: rob.fowler@sunnybrook.ca

24 College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Department of Infection Prevention and Control, Ministry of the National Guard – Health Affairs, Riyadh, Saudi Arabia. Electronic address: BalkhyH@ngha.med.sa.

25 International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC), Infectious Diseases Data Observatory, Oxford University, Oxford, United Kingdom. Electronic address: laura.merson@ndm.ox.ac.uk.

26 International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC), Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States. Electronic address: fgh@virginia.edu.

Year of Publication:

2019

DOI:

10.1016/j.ijid.2019.01.041

Abstract:

BACKGROUND:
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).

CONCLUSION:
These findings indicate that macrolide therapy is not associated with a reduction in 90-day mortality or improvement in MERS-CoV RNA clearance.