| アブストラクト | BACKGROUND: Community-acquired pneumonia (CAP) is the most common cause of acute respiratory distress syndrome (ARDS). Although previous studies have suggested that macrolide therapy is beneficial for ARDS, its benefit for severe CAP-associated ARDS remains uncertain. Previous studies were limited in that they had a small sample size and included patients with non-pulmonary ARDS and those with pulmonary ARDS. This study aimed to investigate the additional effect of azithromycin when used with beta-lactam compared with the effect of beta-lactam alone in mechanically ventilated patients with CAP-associated ARDS. METHODS: We identified mechanically ventilated patients with CAP-associated ARDS between July 2010 and March 2015 using data in the Diagnosis Procedure Combination database, a Japanese nationwide inpatient database. We performed propensity score matching analysis to assess 28-day mortality and in-hospital mortality in mechanically ventilated patients with CAP-associated ARDS who received beta-lactam with and without azithromycin within hospital 2 days after admission. The inverse probability of treatment weighting analysis was also conducted. RESULTS: Eligible patients (n = 1257) were divided into the azithromycin group (n = 226) and the control group (n = 1031). The one-to-four propensity score matching analysis included 139 azithromycin users and 556 non-users. No significant difference was observed between the groups with respect to 28-day mortality (34.5% vs. 37.6%, p = 0.556) or in-hospital mortality (46.0% vs. 49.1%, p = 0.569). The inverse probability of treatment weighting analysis showed similar results. CONCLUSIONS: Compared with treatment with beta-lactam alone, treatment with azithromycin plus beta-lactam had no significant additional effect on 28-day mortality or in-hospital mortality in mechanically ventilated patients with CAP-associated ARDS. To the best of our knowledge, this study is the first to determine the effect of azithromycin in mechanically ventilated patients with CAP-associated ARDS. |
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| 投稿者 | Suzuki, Jun; Sasabuchi, Yusuke; Hatakeyama, Shuji; Matsui, Hiroki; Sasahara, Teppei; Morisawa, Yuji; Yamada, Toshiyuki; Fushimi, Kiyohide; Yasunaga, Hideo |
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| 組織名 | Division of Infectious Diseases, Jichi Medical University Hospital, 3311-1;Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan. j-suzuki@tohoku-mpu.ac.jp.;Center for Data Science, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke,;Tochigi, 329-0498, Japan.;Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.;Division of General Medicine, Jichi Medical University, 3311-1 Yakushiji,;Shimotsuke, Tochigi, 329-0498, Japan.;Department of Clinical Epidemiology and Health Economics, School of Public;Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.;Department of Infection and Immunity, School of Medicine, Jichi Medical;University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.;Department of Clinical Laboratory Medicine, Jichi Medical University, 3311-1;Department of Health Policy and Informatics, Tokyo Medical and Dental University;Graduate School of Medicine, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan. |
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