Iannini P B, Paladino J A, Lavin B, Singer M E, Schentag J J
Yale University School of Medicine, New Haven, CT, USA.
J Chemother. 2007 Oct;19(5):536-45. doi: 10.1179/joc.2007.19.5.536.
This was a retrospective, multi-center study of patients admitted to hospital with community-acquired pneumonia, caused by Streptococcus pneumoniae, after failing to respond to >2 days of outpatient macrolide therapy. 122 cases, treated between 2000-2004, were enrolled from 31 North American sites between January 2004 - March 2005. Non-susceptible isolates (predominately low-level resistance: erythromycin MICs of 1-16 mcg/ml) were recovered from 87 patients (71%). Bacteremia was present in 63 patients (52%). The in-hospital mortality rate was 5.7 %; all 7 patients who died were bacteremic, 6 had a non-susceptible isolate. We report here the largest series of macrolide failures published to date. The patients were notable for their high rates of macrolide resistance, bacteremia, and mortality. High-level macrolide resistance remains rare among US patients failing outpatient macrolides. The majority of cases and virtually all of the mortality occurred in patients with low-level resistant strains.
这是一项回顾性多中心研究，研究对象为因肺炎链球菌引起社区获得性肺炎且在接受门诊大环内酯类药物治疗超过2天无效后入院的患者。2004年1月至2005年3月期间，从北美31个地点纳入了2000 - 2004年期间治疗的122例患者。87例患者（71%）分离出非敏感菌株（主要为低水平耐药：红霉素MIC为1 - 16 mcg/ml）。63例患者（52%）存在菌血症。院内死亡率为5.7%；死亡的7例患者均有菌血症，6例有非敏感菌株。我们在此报告了迄今为止发表的最大系列大环内酯类药物治疗失败病例。这些患者的特点是大环内酯类耐药、菌血症和死亡率高。在美国门诊大环内酯类药物治疗失败的患者中，高水平大环内酯类耐药仍然很少见。大多数病例以及几乎所有死亡病例都发生在低水平耐药菌株的患者中。
