Pneumonia acquired in the community through drug-resistant Streptococcus pneumoniae
Pneumonia acquired in the community through drug-resistant Streptococcus pneumoniae
复制标题
DOI：
10.1164/ajrccm.159.6.9808049
复制
发表时间：
1999-06-01
影响因子：
24.7
通讯作者：
Mensa, J
中科院分区：
文献类型：
--
作者：
Ewig, S;Ruiz, M;Mensa, J
本研究的目的是确定肺炎链球菌耐药的发生率和危险因素，以及其对社区获得性肺炎球菌肺炎住院患者预后的影响。前瞻性研究了培养证实的肺炎球菌性肺炎患者的肺炎球菌耐药发生率、潜在危险因素和住院结局变量。共研究了101例患者。101例患者中有52例（52%）的肺炎球菌对青霉素、头孢菌素或大环内酯类药物耐药;其中49%的分离株对青霉素耐药（16%中度耐药，33%高度耐药），31%对头孢菌素耐药（22%中度耐药，9%高度耐药），27%对大环内酯类药物耐药。在免疫功能正常的患者中，年龄> 65岁与头孢菌素耐药显著相关（比值比[OR]：5.0; 95%可信区间[CI]：1.3 ~ 18.8，p = 0.01），与存在> 2种青霉素耐药合并症显著相关（OR：4.7; 95% CI：1.2 ~ 19.1; p < 0.05）。在免疫抑制患者中，菌血症与青霉素和头孢菌素耐药呈负相关（OR：0.04; 95% CI：0.003 - 0.45; p < 0.005; OR：0.46; 95% CI：0.23 - 0.93; p < 0.05）。耐药性对住院时间、肺炎严重程度和并发症无显著影响。有任何耐药性的患者死亡率为15%，而无耐药性的患者死亡率为6%。然而，任何耐药性与死亡均无显著相关性（相对风险[RR]：2.5; 95% CI：0.7 - 8.9; p = 0.14）。此外，存在不一致的抗菌治疗的归因死亡率为12%，而不存在此类治疗的归因死亡率为10%（RR：1.2; 95%CI：0.3 - 5.3; p = 0.67）。我们的结论是耐药肺炎球菌的发病率很高。耐药的危险因素包括高龄、合并症和菌血症（反之亦然）。耐药性对预后无显著影响。
The aim of the study was to determine the incidence of and risk factors for drug resistance of Streptococcus pneumoniae, and its impact on the outcome among hospitalized patients of pneumococcal pneumonia acquired in the community. Consecutive patients with culture-proven pneumococcal pneumonia were prospectively studied with regard to the incidence of pneumococcal drug resistance, potential risk factors, and in-hospital outcome variables. A total of 101 patients were studied. Drug resistance to penicillin, cephalosporin, or a macrolide drug was found in pneumococci from 52 of the 101 (52%) patients; 49% of these isolates were resistant to penicillin (16% intermediate resistance, 33% high resistance), 31% to cephalosporin (22% intermediate and 9% high resistance), and 27% to a macrolide drug. In immunocompetent patients, age > 65 yr was significantly associated with resistance to cephalosporin (odds ratio [OR]: 5.0; 95% confidence interval [CI]: 1.3 to 18.8, p = 0.01), and with the presence of > 2 comorbidities with resistance to penicillin (OR: 4.7; 95% CI: 1.2 to 19.1; p < 0.05). In immunosuppressed patients, bacteremia was inversely associated with resistance to penicillin and cephalosporin (OR: 0.04; 95% CI: 0.003 to 0.45; p < 0.005; and OR: 0.46; 95% CI: 0.23 to 0.93; p < 0.05, respectively). Length of hospital stay, severity of pneumonia, and complications were not significantly affected by drug resistance. Mortality was 15% in patients with any drug resistance, as compared with 6% in those without resistance. However, any drug resistance was not significantly associated with death (relative risk [RR]: 2.5; 95% CI: 0.7 to 8.9; p = 0.14). Moreover, attributable mortality in the presence of discordant antimicrobial treatment was 12%, as compared with 10% (RR: 1.2; 95% CI: 0.3 to 5.3; p = 0.67) in the absence of such treatment. We conclude that the incidence of drug-resistant pneumococci was high. Risk factors for drug resistance included advanced age, comorbidity, and (inversely) bacteremia. Outcome was not significantly affected by drug resistance.