Johnson Joseph M, Yost Raymond J, Pangrazzi Mark H, Golden Katri A, Soubani Ayman O, Wahby Krista A
Department of Pharmacy, Henry Ford Hospital, Detroit, MI, USA.
Department of Pharmacy, Detroit Receiving Hospital, Detroit, MI, USA.
J Pharm Pract. 2023 Jun;36(3):559-565. doi: 10.1177/08971900211064193. Epub 2021 Dec 30.
Although there is evidence describing the immunomodulatory effects of macrolide antibiotics, there is little literature exploring the clinical effects these properties may have and their impact on measurable outcomes. The purpose of this study was to determine if empiric antimicrobial regimens containing azithromycin shorten time to shock resolution. A retrospective study was performed in adults with septic shock admitted to intensive care units (ICUs) of 3 university-affiliated, urban teaching hospitals between June 2012 and June 2016. Eligible patients with septic shock required treatment with norepinephrine as the first-line vasopressor for a minimum of 4 hours and received at least 48 hours of antimicrobial treatment from the time of shock onset. Propensity scores were utilized to match patients who received azithromycin to those who did not. A total of 3116 patients met initial inclusion criteria. After propensity score matching, 258 patients were included, with 124 and 134 patients in the azithromycin and control groups, respectively. Median shock duration was similar in patients treated with or without azithromycin (45.6 hr vs 59.7 hr, = .44). In-hospital mortality was also similar (37.9% vs 38.1%, = .979). There were no significant differences in mechanical ventilation duration, ICU length of stay (LOS), or hospital LOS. In patients admitted to the ICU with septic shock, empiric azithromycin did not have a significant effect on shock duration, mechanical ventilation duration, ICU LOS, hospital LOS, or in-hospital mortality.
尽管有证据描述了大环内酯类抗生素的免疫调节作用，但很少有文献探讨这些特性可能产生的临床效果及其对可测量结果的影响。本研究的目的是确定含阿奇霉素的经验性抗菌方案是否能缩短休克缓解时间。对2012年6月至2016年6月期间入住3家大学附属城市教学医院重症监护病房（ICU）的感染性休克成年患者进行了一项回顾性研究。符合条件的感染性休克患者需要使用去甲肾上腺素作为一线血管升压药治疗至少4小时，且从休克发作时起接受至少48小时的抗菌治疗。利用倾向评分将接受阿奇霉素治疗的患者与未接受阿奇霉素治疗的患者进行匹配。共有3116名患者符合初始纳入标准。倾向评分匹配后，纳入258名患者，阿奇霉素组和对照组分别有124名和134名患者。接受或未接受阿奇霉素治疗的患者的中位休克持续时间相似（45.6小时对59.7小时，P = 0.44）。住院死亡率也相似（37.9%对38.1%，P = 0.979）。机械通气时间、ICU住院时间（LOS）或医院住院时间无显著差异。在入住ICU的感染性休克患者中，经验性使用阿奇霉素对休克持续时间、机械通气时间、ICU LOS、医院LOS或住院死亡率没有显著影响。
