Chest：大环内酯类抗生素可降低急性肺损伤者死亡率

Macrolide Antibiotics and Survival in Patients with Acute Lung Injury.

Walkey AJ, Wiener RS.

BACKGROUND:
Animal models suggest that immunomodulatory properties of macrolide antibiotics have therapeutic value during acute lung injury. We investigated the association between receipt of macrolide antibiotics and clinical outcomes in patients with acute lung injury.
METHODS:
Secondary analysis of multicenter, randomized, controlled trial data from the Acute Respiratory Distress Syndrome Network (ARDSNet) Lisofylline and Respiratory Management of Acute Lung Injury Trial, which collected detailed data regarding antibiotic use among participants with acute lung injury.
RESULTS:
47 (20%) of 235 participants received a macrolide antibiotic within 24 hours of trial enrollment. Among patients who received a macrolide, erythromycin was most common (57%), followed by azithromycin (40%). The median duration of macrolide use after study enrollment was 4 days (interquartile range 2-8). 11/47 (23%) who received macrolides died as compared with 67/188 (36%) who did not receive a macrolide, p=0.11. Participants administered macrolides were more likely to have pneumonia as an acute lung injury risk factor, were less likely to have non-pulmonary sepsis or to be randomized to low tidal volume ventilation, and had 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% confidence interval 0.23-0.92, p=0.028] and shorter time to successful discontinuation of mechanical ventilation (HR 1.93, 95% CI 1.18-3.17, p=0.009). In contrast, fluoroquinolone (n=90) and cephalosporin antibiotics (n=93) were not associated with improved outcomes.
CONCLUSIONS:
Macrolide antibiotics were associated with improved outcomes in acute lung injury.