Breakthrough Pneumococcal Bacteremia in Patients Being Treated with Azithromycin and Clarithromycin

Kelley, Meera; Weber, David J.; Gilligan, Peter H.; Cohen, Myron S.

doi:10.1086/318157

Cited by 217 publications

(131 citation statements)

References 19 publications

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“…Prior antibiotic therapy was also a significant risk factor for harboring a penicillin and cephalosporin resistant organism. This is consistent with the results of numerous other studies, (7,8,12,25,26) and is not surprising, considering that the selective pressure exerted on organisms by antibiotics, forces species to develop mechanisms of resistance to allow for its survival. These results should be framed in the context that it is likely that the patients included in this study had organisms which were already resistant to the antibiotic prescribed.…”

Section: Discussionsupporting

confidence: 92%

“…(5, [16][17][18][19] Despite widespread reports of decreased susceptibility of S. pneumoniae to penicillins, cephelosporins, and macrolides, these remain the most commonly prescribed antibiotics for both children and adults with community acquired pneumonia in the United States and Canada. (4,12) With increasing rates of antibiotic resistance of S. pneumoniae, decisions on treatment of patients with such infections may depend on local antimicrobial susceptibility, as well as clinical outcomes of patients treated with these antibiotics. Prior studies investigating the clinical relevance of antibiotic resistance and mortality in pneumococcal disease have been based on a much smaller number of patients.…”

Section: Discussionmentioning

confidence: 99%

“…Prior studies investigating the clinical relevance of antibiotic resistance and mortality in pneumococcal disease have been based on a much smaller number of patients. (11,12) In this large, retrospective mulitcenter cohort study of patients with pneumococcal bacteremia, we determine the relationship between prior antibiotic use and antibiotic resistance, and also determine which factors are associated with antibiotic resistance. We found that in addition to prior antibiotic use, having S. pneumoniae isolated from another site in addition to blood, residing the Southern US, and having an allergy to an antibiotic are independent risk factors for harboring a macrolide resistant organism.…”

Section: Discussionmentioning

confidence: 99%

“…Some recent reports, however, are worrisome with reported development of pneumococcal bacteremia among patients receiving azithromycin or clarithromycin therapy, in association with low-level resistant strains. (12)(13)(14)(15) We performed this large multicenter U.S. study including over 1500 patients with pneumococcal bacteremia in order to increase our understanding regarding factors associated with antibiotic resistance and associated mortality. We will describe the susceptibility pattern of pneumococcal isolates in this cohort, and will determine the factors associated with antibiotic resistance and mortality.…”

Section: Introductionmentioning

confidence: 99%

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Factors Associated With Antimicrobial Resistance and Mortality in Pneumococcal Bacteremia

Neuman

Kelley

Harper

et al. 2007

The Journal of Emergency Medicine

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We conducted a multicenter, retrospective cohort study of patients with Streptococcus pneumoniae bacteremia to determine factors associated with antibiotic resistance and mortality. Risk factors were identified using multivariate logistic regression. 1,574 patients at 34 sites were enrolled. Compared to isolates from patients not receiving an antibiotic before the index blood culture, patients receiving an antibiotic were less likely to harbor an antibiotic susceptible organism. Susceptibility to penicillin decreased from 78% (95% confidence interval [CI], 75−80) to 49% (95%CI, 39−59); to cefotaxime/ ceftriaxone, from 92% (95%CI, 90−93) to 82% (95%CI, 72−89); and to macrolide, from 84% (95% CI, 82−87) to 55% (95%CI, 41−68). Factors associated with macrolide non-susceptibility include: >24 hours of antibiotic therapy at time of the index culture (odds ratio [OR] 4.0), residing in southern U.S. (OR 1.7), and having an antibiotic allergy (OR 1.7). Harboring an antibiotic non-susceptible strain (OR 1.4) and male sex (OR 1.4) were associated with increased risk of mortality, whereas Black race (OR 0.6) and evidence of focal infection (OR 0.6) were associated with decreased risk.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Factors Associated With Antimicrobial Resistance and Mortality in Pneumococcal Bacteremia

Neuman

Kelley

Harper

et al. 2007

The Journal of Emergency Medicine

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“…Levofloxacin was the least active agent (higher MPC values) by these measurements and it was predicted that levofloxacin was more likely to select for resistant subpopulations than the other agents; of the agents tested, only levofloxacin and moxifloxacin remain in clinical practice. In 2002, Davidson et al [38], reported on the selection of levofloxacin resistant S. pneumoniae in patients infected with this organism and treated with levofloxacin and numerous subsequent reports have identified the same pattern of resistance selection during antimicrobial therapy with macrolides [39][40][41].…”

Section: Measuring Resistancementioning

confidence: 99%

Application of the Formula for Rational Antimicrobial Therapy (FRAT) to Community-Acquired Pneumonia

Blondeau¹,

Theriault²

2017

J Infect Dis Ther

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Community-acquired pneumonia (CAP) remains a common condition for which patients seek medical advice in the outpatient setting and where antimicrobial agents are prescribed empirically-often based on therapeutic guideline recommendations. Antimicrobial resistance impacts on therapeutic choices as resistance is associated with clinical failure which in turn may impact morbidity and mortality. The Formal for Rational Antimicrobial Therapy (FRAT) considers etiology and antimicrobial susceptibility to generate a factor to predict the likely activity of an antimicrobial agent in CAP or any other infection for which etiology and susceptibility data can be considered. In considering the FRAT formula in CAP, amoxicillin and macrolides offer a predictability of 52.6-78.3% whereas for trimethoprim/sulfamethoxazole the predictability was 45.2% as compared to 90.1% for tetracyclines/doxycycline and 98.2% for levofloxacin (and moxifloxacin). The FRAT formula clearly differentiates antimicrobial agents based on spectrum of activity and impact of antimicrobial resistance and provides yet another factor for consideration in the selection of an antimicrobial agent for treatment of CAP.

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A Fresh Look at the Definition of Susceptibility of Streptococcus pneumoniae to β-Lactam Antibiotics

Musher

Bartlett²,

Doern³

2001

Arch Intern Med

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Definitions for susceptibility or resistance of Streptococcus pneumoniae to penicillin were not developed until penicillin-resistant pneumococci appeared in South Africa in the late 1970s. The definition that was accepted (which still remains in use) and later definitions of resistance to most other beta-lactam antibiotics were derived from laboratory and clinical data relating to the treatment of meningitis, not otitis media, sinusitis, or pneumonia. An understanding of the origin of these definitions helps to resolve the apparent paradox that infections of the respiratory tract due to seemingly beta-lactam-resistant pneumococci may still respond well to standard doses of these drugs. A recently sanctioned change in the definition of susceptibility to amoxicillin is helpful in eliminating the paradox for this drug, but it may create further confusion by implying that, on a microgram basis, amoxicillin is substantially more effective than penicillin or third-generation cephalosporins. This article examines definitions of susceptibility and resistance of pneumococci, highlighting areas that have led to confusion and proposing a new way of understanding them.

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Breakthrough Pneumococcal Bacteremia in Patients Being Treated with Azithromycin and Clarithromycin

Cited by 217 publications

References 19 publications

Factors Associated With Antimicrobial Resistance and Mortality in Pneumococcal Bacteremia

Factors Associated With Antimicrobial Resistance and Mortality in Pneumococcal Bacteremia

Application of the Formula for Rational Antimicrobial Therapy (FRAT) to Community-Acquired Pneumonia

A Fresh Look at the Definition of Susceptibility of Streptococcus pneumoniae to β-Lactam Antibiotics

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