1 Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Ciber de Enfermedades Respiratorias, Barcelona, Spain.
Am J Respir Crit Care Med. 2015 Jun 1;191(11):1265-72. doi: 10.1164/rccm.201502-0212OC.
There are conflicting reports describing the effect of macrolide resistance on the presentation and outcomes of patients with Streptococcus pneumoniae pneumonia.
We aimed to determine the effect of macrolide resistance on the presentation and outcomes of patients with pneumococcal pneumonia.
We conducted a retrospective, observational study in the Hospital Clinic of Barcelona of all adult patients hospitalized with pneumonia who had positive cultures for S. pneumoniae from January 1, 2000 to December 31, 2013. Outcomes examined included bacteremia, pulmonary complications, acute renal failure, shock, intensive care unit admission, need for mechanical ventilation, length of hospital stay, and 30-day mortality.
Of 643 patients hospitalized for S. pneumoniae pneumonia, 139 (22%) were macrolide resistant. Patients with macrolide-resistant organisms were less likely to have bacteremia, pulmonary complications, and shock, and were less likely to require noninvasive mechanical ventilation. We found no increase in the incidence of acute renal failure, the frequency of intensive care unit admission, the need for invasive ventilatory support, the length of hospital stay, or the 30-day mortality in patients with (invasive or noninvasive) macrolide-resistant S. pneumoniae pneumonia, and no effect on outcomes as a function of whether treatment regimens did or did not comply with current guidelines.
We found no evidence suggesting that patients hospitalized for macrolide-resistant S. pneumoniae pneumonia were more severely ill on presentation or had worse clinical outcomes if they were treated with guideline-compliant versus noncompliant regimens.
有相互矛盾的报告描述了大环内酯类耐药对肺炎链球菌性肺炎患者的表现和结局的影响。
我们旨在确定肺炎链球菌性肺炎患者中大环内酯类耐药对表现和结局的影响。
我们对巴塞罗那临床医院 2000 年 1 月 1 日至 2013 年 12 月 31 日期间所有因肺炎住院且培养出肺炎链球菌阳性的成年患者进行了回顾性、观察性研究。检查的结局包括菌血症、肺部并发症、急性肾功能衰竭、休克、重症监护病房入院、需要机械通气、住院时间和 30 天死亡率。
在因肺炎链球菌住院的 643 例患者中，有 139 例（22%）对大环内酯类耐药。大环内酯类耐药菌患者发生菌血症、肺部并发症和休克的可能性较小，且不太可能需要无创机械通气。我们发现，在有（侵入性或非侵入性）大环内酯类耐药肺炎链球菌性肺炎的患者中，急性肾功能衰竭的发生率、重症监护病房入院的频率、需要有创通气支持、住院时间或 30 天死亡率均无增加，且治疗方案是否符合现行指南也没有对结果产生影响。
我们没有发现证据表明，因大环内酯类耐药肺炎链球菌性肺炎住院的患者在就诊时病情更严重，或者如果他们接受符合指南与不符合指南的治疗方案，其临床结局更差。
