Abstract
We conducted a case-control study of adults with bacteremic pneumococcal pneumonia to identify factors associated with macrolide resistance. Study participants were identified through population-based surveillance in a 5-county region surrounding Philadelphia. Forty-three hospitals contributed 444 patients, who were interviewed by telephone regarding potential risk factors. In multivariable analyses, prior exposure to a macrolide antimicrobial agent (odds ratio [OR] 2.8), prior flu vaccination (OR 2.0), and Hispanic ethnicity (OR 4.1) were independently associated with an increased probability of macrolide resistance, and a history of stroke was independently associated with a decreased probability of macrolide resistance (OR 0.2). Fifty-five percent of patients with macrolide-resistant infections reported no antimicrobial drug exposure in the preceding 6 months. Among patients who reported taking antimicrobial agents in the 6 months preceding infection, failure to complete the course of prescribed drugs was associated with an increased probability of macrolide resistance (OR 3.4).
Highlights
Streptococcus pneumoniae is the leading cause of community-acquired pneumonia in adults
While our current study found that exposure to the Discussion In this case-control study of 444 adults with bacteremic pneumococcal pneumonia, we found that exposure to macrolides in the 6 months preceding infection, a history of influenza vaccination in the 12 months preceding infection, and Hispanic ethnicity were all independently associated with an increased probability of an erythromycinresistant infection
Many of these risk factors may be identified only because they are associated with higher probabilities of prior antimicrobial drug exposure, which may have been incompletely measured by our questions on prior drug use
Summary
Streptococcus pneumoniae is the leading cause of community-acquired pneumonia in adults. Drug-resistant pneumococci clearly emerge under the selective forces of antibacterial drugs used in the population. Pneumococcal resistance to macrolides is a problem because macrolides are among the most common oral drugs used to treat patients with community-acquired pneumonia [5]. Since most initial therapy of community-acquired pneumonia is empiric, estimating the probability of macrolideresistant pneumococcal disease is necessary to select appropriate therapy. Current treatment guidelines recommend not prescribing macrolide therapy alone for patients with community-acquired pneumonia if they report exposure to macrolides within the 3 months preceding the onset of illness [7]. We conducted a population-based case-control study to identify clinical and demographic factors independently associated with macrolide-resistant bacteremic pneumococcal pneumonia in adults. We used a detailed multistage interview method to elicit in-depth histories of exposure to antimicrobial agents to examine whether disease probability varied across different patterns of antibacterial drug exposure
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