Failure of macrolide antibiotic treatment in patients with bacteremia due to erythromycin-resistant Streptococcus pneumoniae
Failure of macrolide antibiotic treatment in patients with bacteremia due to erythromycin-resistant Streptococcus pneumoniae
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DOI：
10.1086/341978
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发表时间：
2002-09-01
影响因子：
11.8
通讯作者：
Medeiros, AA
中科院分区：
文献类型：
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作者：
Lonks, JR;Garau, J;Medeiros, AA
肺炎链球菌对大环内酯类抗生素的耐药率正在上升，但一些研究者对其临床相关性提出了质疑。我们对4家医院的菌血症性肺炎球菌感染患者进行了一项配对病例对照研究，以确定大环内酯类药物治疗期间爆发性菌血症的发生是否与肺炎球菌分离株对大环内酯类药物的敏感性有关。病例患者（n = 86）为肺炎球菌菌血症患者，分离株对红霉素耐药或中度耐药。对照组（n = 141）为年龄、性别、地点和菌血症发生年份相匹配的分离出红霉素敏感性肺炎球菌的患者。排除脑膜炎患者，76例患者中有18例（24%）和136例匹配对照中无一例在采集血液进行培养时服用大环内酯类药物（P = .00000012）。此外，21例低水平耐药M表型患者中有5例（24%）正在服用大环内酯类药物，而40例对照患者中无一人服用大环内酯类药物（P = 0.00157）。这些数据表明，在大环内酯类或氮杂内酯类治疗过程中，感染红霉素耐药肺炎球菌的患者更可能发生突破性菌血症，并且它们还表明，由外排和甲基化酶机制引起的体外大环内酯类耐药具有临床相关性。
The rate of macrolide resistance among Streptococcus pneumoniae is increasing, but some investigators have questioned its clinical relevance. We conducted a matched case-control study of patients with bacteremic pneumococcal infection at 4 hospitals to determine whether development of breakthrough bacteremia during macrolide treatment was related to macrolide susceptibility of the pneumococcal isolate. Case patients (n = 86) were patients who had pneumococcal bacteremia and an isolate that was either resistant or intermediately resistant to erythromycin. Controls (n = 141) were patients matched for age, sex, location, and year that bacteremia developed who had an erythromycin-susceptible pneumococcus isolated. Excluding patients with meningitis, 18 (24%) of 76 case patients and none of 136 matched controls were taking a macrolide when blood was obtained for culture (P = .00000012). Moreover, 5 (24%) of 21 case patients with the low-level-resistant M phenotype and none of 40 controls were taking a macrolide (P = .00157). These data show that development of breakthrough bacteremia during macrolide or azalide therapy is more likely to occur among patients infected with an erythromycin-resistant pneumococcus, and they also indicate that in vitro macrolide resistance resulting from both the efflux and methylase mechanisms is clinically relevant.