Temporal Trends in Phenotypic Macrolide and Nonmacrolide Resistance for Streptococcus pneumoniae Nasopharyngeal Samples Up to 36 Months after Mass Azithromycin Administration in a Cluster-Randomized Trial in Niger.
Temporal Trends in Phenotypic Macrolide and Nonmacrolide Resistance for Streptococcus pneumoniae Nasopharyngeal Samples Up to 36 Months after Mass Azithromycin Administration in a Cluster-Randomized Trial in Niger.
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DOI：
10.4269/ajtmh.23-0431
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发表时间：
2023-11-01
期刊：
影响因子：
--
通讯作者：
Blumberg S
中科院分区：
文献类型：
--
作者：
Hazel A;Arzika AM;Abdou A;Lebas E;Porco TC;Maliki R;Doan T;Lietman TM;Keenan JD;Blumberg S
阿奇霉素大规模给药可降低儿童死亡率，但也会选择抗生素耐药性。在此，我们评估了阿奇霉素MDA后鼻咽部肺炎链球菌对大环内酯类药物的耐药性。在一项整群随机试验中，1-59 个月的儿童每半年接受阿奇霉素或安慰剂治疗。每个组随机选择 15 个村庄进行抗菌药物耐药性检测，并从每个村庄的登记儿童中随机抽取 10-15 个拭子进行肺炎链球菌分离和耐药性检测。主要预先设定的结果是 36 个月时阿奇霉素与安慰剂村的大环内酯类耐药分数。次要的非预设结果是阿奇霉素和安慰剂的比较：1) 12、24 和 36 个月时的大环内酯类药物耐药性； 2) 36个月时非大环内酯类药物耐药； 3）疑似erm突变。 36 个月时，获得了 423 份拭子，其中 322 份培养出肺炎链球菌（阿奇霉素：146/202，安慰剂：176/221）。治疗组的平均耐药率并不显着高于安慰剂组（混合效应模型：14.6% vs. 8.9%；OR = 2.0，95% CI：0.99–3.97）。然而，当评估所有时间点时，阿奇霉素组的大环内酯类耐药率显着较高（β = 0.102，95% CI：0.04–0.167）。对于所有非大环内酯类药物，36 个月时的耐药率在两组之间没有差异。阿奇霉素和安慰剂在疑似 erm 突变发生率方面没有差异。阿奇霉素组的大环内酯类耐药性在所有时间点均较高，但在 36 个月时则不然。尽管这表明每年两次 MDA 后耐药性可能不会继续增加，但仍需要更多研究来阐明 MDA 何时可以安全地降低低收入和中等收入国家的死亡率和发病率。
Azithromycin mass drug administration decreases child mortality but also selects for antibiotic resistance. Herein, we evaluate macrolide resistance of nasopharyngeal Streptococcus pneumoniae after azithromycin MDA. In a cluster-randomized trial, children 1–59 months received azithromycin or placebo biannually. Fifteen villages from each arm were randomly selected for antimicrobial resistance testing, and 10–15 randomly selected swabs from enrolled children at each village were processed for S. pneumoniae isolation and resistance testing. The primary prespecified outcome was macrolide resistance fraction for azithromycin versus placebo villages at 36 months. Secondary non-prespecified outcomes were comparisons of azithromycin and placebo for: 1) macrolide resistance at 12, 24, and 36 months; 2) nonmacrolide resistance at 36 months; and 3) suspected-erm mutation. At 36 months, 423 swabs were obtained and 322 grew S. pneumoniae, (azithromycin: 146/202, placebo: 176/221). Mean resistance prevalence was non-significantly higher in treatment than placebo (mixed-effects model: 14.6% vs. 8.9%; OR = 2.0, 95% CI: 0.99–3.97). However, when all time points were evaluated, macrolide resistance prevalence was significantly higher in the azithromycin group (β = 0.102, 95% CI: 0.04–0.167). For all nonmacrolides, resistance prevalence at 36 months was not different between the two groups. Azithromycin and placebo were not different for suspected-erm mutation prevalence. Macrolide resistance was higher in the azithromycin group over all time points, but not at 36 months. Although this suggests resistance may not continue to increase after biannual MDA, more studies are needed to clarify when MDA can safely decrease mortality and morbidity in lower- and middle-income countries.
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影响因子：
8.1
作者：
通讯作者：
--
DOI：
10.1111/j.2517-6161.1995.tb02031.x
发表时间：
1995-01-01
影响因子：
5.8
作者：
BENJAMINI, Y;HOCHBERG, Y
通讯作者：
HOCHBERG, Y
DOI：
10.1073/pnas.2013694117
发表时间：
2020-11-17
影响因子：
11.1
作者：
Olesen SW;Lipsitch M;Grad YH
通讯作者：
Grad YH
DOI：
10.1093/cid/ciaa1905
发表时间：
2021-10-05
期刊：
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
影响因子：
--
作者：
Phiri MD;Cairns M;Zongo I;Nikiema F;Diarra M;Yerbanga RS;Barry A;Tapily A;Coumare S;Thera I;Kuepfer I;Milligan P;Tinto H;Dicko A;Ouédraogo JB;Greenwood B;Chandramohan D;Sagara I
通讯作者：
Sagara I
影响因子：
11.8
作者：
Amza, Abdou;Kadri, Boubacar;Lietman, Thomas M.
通讯作者：
Lietman, Thomas M.