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or Fluoroquinolones Were Not Associated With Cardiovascular Events in Mechanically-Ventilated Patients
October 2013, Vol 144, No. 4_MeetingAbstracts Cardiovascular Disease | October 2013
Macrolides and/or Fluoroquinolones Were Not Associated With Cardiovascular Events in Mechanically-Ventilated Patients Juan Fernandez, MD; A. Anzueto, MD; Marcos Restrepo, MD UTHSCSA, San Antonio, TX Chest. 2013;144(4_MeetingAbstracts):163A. doi:10.1378/chest.1704846
Abstract SESSION TITLE: Cardiovascular Posters SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM PURPOSE: Cardiovascular (CV) events have been associated in patients treated with macrolides and fluoroquinolones (FQs). Clinical practice guidelines recommend the use of these medications in critically ill patients with severe infections in the intensive care unit (ICU), including pneumonia and sepsis. However, limited information is available regarding the effect of macrolides and FQs in CV events. Therefore, our aim was to evaluate the risk of developing CV events in critically ill patients requiring mechanical ventilation that received macrolides/FQs. METHODS: A retrospective cohort study of critically ill patients requiring mechanical ventilation (MV) for ≥ 1day were identified from January 1 to December 31, 2007. Exposure group included patients that received at least one dose of a macrolide (azithromycin, clarithromycin or erythromycin) and/or a FQ (ciprofloxacin or moxifloxacin) during their hospitalization. Primary composite outcome was CV events that included mortality, cardiorespiratory arrest and/or ventricular fibrillation or ventricular tachycardia during hospitalization. Chi-square and Student s t-test were used to compare categorical and continuous variables, respectively. Multivariable analysis was performed using the composite outcome as the dependent variable and the exposure agents and prolonged QT as the independent variables. RESULTS: We identified 153 patients that required MV, 42 (27%) received a macrolide, 71 (46%) FQs and 89 (58%) macrolides/FQs. Fifty seven (37%) patients developed a CV event during hospitalization. In the multivariable analysis the use of macrolides (30% vs. 23%, aOR 0.7, 95% CI 0.3-1.5; p=.3), FQs (48% vs. 44%; aOR 0.9, 95% CI 0.4-1.7, p=.6) and macrolides/FQ (61% vs. 53%, aOR 0.7, 95% CI 0.4-1.3, p=.3) were not associated with the CV
events when compared to non-users who received MV. Individual macrolides or FQs were also not associated with CV events. CONCLUSIONS: The use of macrolides and/or FQ was not associated with higher rate of CV events among critically ill patients requiring mechanical ventilation. CLINICAL IMPLICATIONS: Further prospective studies are needed to evaluate the safety of macrolides and/or FQ in critically ill patients. DISCLOSURE: The following authors have nothing to disclose: Juan Fernandez, A. Anzueto, Marcos Restrepo No Product/Research Disclosure Information
Macrolides and/or Fluoroquinolones Were Not Associated With Cardiovascular Events in Mechanically-Ventilated Patients Juan Fernandez, MD; A. Anzueto, MD; Marcos Restrepo, MD UTHSCSA, San Antonio, TX Chest. 2013;144(4_MeetingAbstracts):163A. doi:10.1378/chest.1704846
Abstract SESSION TITLE: Cardiovascular Posters SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM PURPOSE: Cardiovascular (CV) events have been associated in patients treated with macrolides and fluoroquinolones (FQs). Clinical practice guidelines recommend the use of these medications in critically ill patients with severe infections in the intensive care unit (ICU), including pneumonia and sepsis. However, limited information is available regarding the effect of macrolides and FQs in CV events. Therefore, our aim was to evaluate the risk of developing CV events in critically ill patients requiring mechanical ventilation that received macrolides/FQs. METHODS: A retrospective cohort study of critically ill patients requiring mechanical ventilation (MV) for ≥ 1day were identified from January 1 to December 31, 2007. Exposure group included patients that received at least one dose of a macrolide (azithromycin, clarithromycin or erythromycin) and/or a FQ (ciprofloxacin or moxifloxacin) during their hospitalization. Primary composite outcome was CV events that included mortality, cardiorespiratory arrest and/or ventricular fibrillation or ventricular tachycardia during hospitalization. Chi-square and Student s t-test were used to compare categorical and continuous variables, respectively. Multivariable analysis was performed using the composite outcome as the dependent variable and the exposure agents and prolonged QT as the independent variables. RESULTS: We identified 153 patients that required MV, 42 (27%) received a macrolide, 71 (46%) FQs and 89 (58%) macrolides/FQs. Fifty seven (37%) patients developed a CV event during hospitalization. In the multivariable analysis the use of macrolides (30% vs. 23%, aOR 0.7, 95% CI 0.3-1.5; p=.3), FQs (48% vs. 44%; aOR 0.9, 95% CI 0.4-1.7, p=.6) and macrolides/FQ (61% vs. 53%, aOR 0.7, 95% CI 0.4-1.3, p=.3) were not associated with the CV
events when compared to non-users who received MV. Individual macrolides or FQs were also not associated with CV events. CONCLUSIONS: The use of macrolides and/or FQ was not associated with higher rate of CV events among critically ill patients requiring mechanical ventilation. CLINICAL IMPLICATIONS: Further prospective studies are needed to evaluate the safety of macrolides and/or FQ in critically ill patients. DISCLOSURE: The following authors have nothing to disclose: Juan Fernandez, A. Anzueto, Marcos Restrepo No Product/Research Disclosure Information