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Pneumococal community-acquired pneumonia in the intensive care unit: Azithromycin remains protective despite macrolide resistance
- Source :
- Respiratory medicine. 177
- Publication Year :
- 2020
-
Abstract
- Background Streptococcus pneumoniae (SP) remains the leading pathogen in community-acquired pneumonia (CAP). Despite the increasing prevalence of macrolide resistance in SP, guidelines recommend the use of macrolides as part of a combination regiment for intensive care unit (ICU) patients with CAP. We sought to describe if macrolide resistance effects outcomes in SP CAP in the ICU and if macrolides remain associated with a mortality advantage in an era of greater resistance. Methods We identified all patients with SP CAP admitted to the ICU between January 2012 and December 2016, and hospital mortality represented the primary endpoint. We recorded markers of acute and chronic disease severity (eg, Charlson score, need for mechanical ventilation and/or vasopressors) along with infection-related variables including the presence of macrolide resistance. We compared subjects treated with azithromycin to those not given this agent. Results The cohort included 140 subjects (89.2% on mechanical ventilation, 14.3% crude mortality). Macrolide resistance occurred often (60.8%) and, in univariate analyses, was associated with higher mortality while azithromycin use appeared linked to fewer death. In multivariate analysis controlling for multiple confounders including macrolide resistance and the timeliness and appropriateness of antibiotic therapy, treatment with azithromycin resulted in fewer death (Adjusted odds ratio 0.27, 95% confidence interval: 0.09–0.85, p = 0.024). Macrolide resistance, however, was not independently related to mortality. Conclusions Macrolide resistance appears frequently in SP ICU CAP. The addition of azithromycin to the antibiotic regimen in this scenario is significantly associated with a reduction in in-hospital mortality independent of multiple co-variates.
- Subjects :
- Pulmonary and Respiratory Medicine
Mechanical ventilation
medicine.medical_specialty
Univariate analysis
business.industry
medicine.medical_treatment
Odds ratio
medicine.disease
Azithromycin
medicine.disease_cause
Intensive care unit
law.invention
03 medical and health sciences
Pneumonia
0302 clinical medicine
030228 respiratory system
Community-acquired pneumonia
law
Internal medicine
Streptococcus pneumoniae
medicine
030212 general & internal medicine
business
medicine.drug
Subjects
Details
- ISSN :
- 15323064
- Volume :
- 177
- Database :
- OpenAIRE
- Journal :
- Respiratory medicine
- Accession number :
- edsair.doi.dedup.....17179e31d386c424133a03b3cdd5cc58