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.

中文翻译：

---

重症监护病房中的肺炎球菌社区获得性肺炎：尽管大环内酯类耐药，阿奇霉素仍具有保护作用

背景

肺炎链球菌（SP）仍然是社区获得性肺炎（CAP）的主要病原体。尽管 SP 中大环内酯类药物耐药性的患病率不断增加，但指南建议将大环内酯类药物作为联合治疗方案的一部分用于 CAP 重症监护病房 (ICU) 患者。我们试图描述大环内酯类药物耐药性是否会影响 ICU 中 SP CAP 的结果，以及在耐药性更大的时代，大环内酯类药物是否仍然与死亡率优势相关。

方法

我们确定了 2012 年 1 月至 2016 年 12 月期间入住 ICU 的所有 SP CAP 患者，医院死亡率是主要终点。我们记录了急性和慢性疾病严重程度的标志物（例如，查尔森评分、机械通气和/或血管加压药的需要）以及感染相关变量，包括大环内酯类药物耐药性的存在。我们将接受阿奇霉素治疗的受试者与未接受该药物治疗的受试者进行了比较。

结果

该队列包括 140 名受试者（89.2% 接受机械通气，14.3% 粗死亡率）。大环内酯类药物耐药性经常发生（60.8%），并且在单变量分析中，大环内酯类药物耐药性与较高的死亡率相关，而阿奇霉素的使用似乎与较低的死亡率相关。在控制多种混杂因素（包括大环内酯类耐药性以及抗生素治疗的及时性和适当性）的多变量分析中，阿奇霉素治疗导致死亡较少（调整后的比值比 0.27，95% 置信区间：0.09-0.85，p = 0.024）。然而，大环内酯类耐药性与死亡率并不独立相关。

结论

SP ICU CAP 中经常出现大环内酯类耐药。在这种情况下，在抗生素治疗方案中添加阿奇霉素与院内死亡率的降低显着相关，且与多个协变量无关。