Efficacy of azithromycin in sepsis-associated acute respiratory distress syndrome: a retrospective study and propensity score analysis.

Kodai Kawamura,Yoshihiko Sakata,Yoshitomo Eguchi,Makoto Takaki,Keisuke Anan,Naoki Shingu,Tatuya Nitawaki,Moritaka Suga,Yuko Yasuda,Jyunpei Hisanaga,Kazuya Ichikado,Aoi Tanaka

doi:10.1186/s40064-016-2866-1

Abstract

PurposeAcute respiratory distress syndrome is a life-threatening form of respiratory failure without an established pharmacological treatment. Recently, macrolides have been found to be beneficial in cases of acute lung injury, but evidence is limited.Materials and methodsThis single-centre retrospective cohort evaluation of hospitalized patients with sepsis-associated acute respiratory distress syndrome aimed to assess the impact of azithromycin on clinical outcomes by using a propensity score analysis. All data were collected prospectively as part of ongoing research on high-resolution computed tomography of acute respiratory distress syndrome. The primary outcome was 60-day mortality; the secondary outcome was the number of ventilator-free days.ResultsTwenty-nine of 125 patients with sepsis-associated acute respiratory distress syndrome (23.2 %) received azithromycin within 24 h after acute respiratory distress syndrome diagnosis. After adjusting for potentially confounding covariates, azithromycin use was associated with lower 60-day mortality (hazard ratio, 0.31; 95 % confidence interval, 0.11–082; P = 0.02) and a shorter time to successful discontinuation of mechanical ventilation.ConclusionsAzithromycin use was associated with decreased mortality and ventilator dependency in patients with sepsis-associated acute respiratory distress syndrome. Further well-designed prospective studies are needed.Electronic supplementary materialThe online version of this article (doi:10.1186/s40064-016-2866-1) contains supplementary material, which is available to authorized users.

Highlights

Acute respiratory distress syndrome (ARDS) is a lifethreatening form of respiratory failure that affects a heterogeneous population of critically ill patients
After adjusting for potentially confounding covariates, azithromycin use was associated with lower 60-day mortality and a shorter time to successful discontinuation of mechanical ventilation
Azithromycin use was associated with decreased mortality and ventilator dependency in patients with sepsis-associated acute respiratory distress syndrome

Summary

Introduction

Acute respiratory distress syndrome (ARDS) is a lifethreatening form of respiratory failure that affects a heterogeneous population of critically ill patients. Overall mortality appears to be decreasing in recent years because of improvements in supportive care, the mortality rate from ARDS is approximately 30–40 %, and is still high (Rubenfeld et al 2005; Zambon and Vincent 2008; Force et al 2012). Macrolides have immunomodulatory effects in addition to antimicrobial effects. Macrolides have been shown to reduce mortality in many acute lung injury animal models (Tamaoki 2004; Sato et al 1998; Amado-Rodriguez et al 2013). In humans, Walkey and Wiener (2012) recently proposed that macrolides may benefit patients with acute lung injury. Walkey reported that the most commonly administered macrolide was erythromycin, followed by azithromycin (40 %) in their registry

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