Macrolide Resistance Among Invasive &lt;EMPH TYPE="ITAL"&gt;Streptococcus pneumoniae&lt;/EMPH&gt; Isolates

Hyde, Terri B.; Stephens, David S.; Vugia, Duc J.; Pass, Margaret; Johnson, Susan K.; Barrett, Nancy L.; Schaffner, William; Cieslak, Paul R.; Maupin, Peggy S.; Zell, Elizabeth R.; Jorgensen, James H.; Facklam, Richard R.; Whitney, Cynthia G.

doi:10.1001/jama.286.15.1857

Cited by 289 publications

(198 citation statements)

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“…Permanecem relativamente baixas as cifras para a eritromicina (11,3%) e clindamicina (11,3%), comparáveis com as relatadas em outros estudos nacionais: para eritromicina, valores de 3,8 27 , 5,5 13-15 , 5,7 28 e 6,2% 24 e para clindamicina, valores de 2,9 28 e 3,1% 27 . O fato de 16 cepas resistentes à eritromicina serem também resistentes à clindamicina sugere a manifestação do fenótipo MLS B , caracterizado pela resistência constitutiva aos macrolídeos, lincosaminas e estreptogramina B 29,30 . Não houve resistência in vitro ao cloranfenicol, ofloxacina, rifampicina ou vancomicina.…”

Section: Discussionunclassified

Prevalence of serotypes and antimicrobial resistance of invasive strains of pneumococcus in children: analysis of 9 years

Mantese¹,

Paula²,

Almeida³

et al. 2009

J Pediatr (Rio J)

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Section: Discussionunclassified

Prevalence of serotypes and antimicrobial resistance of invasive strains of pneumococcus in children: analysis of 9 years

Mantese¹,

Paula²,

Almeida³

et al. 2009

J Pediatr (Rio J)

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“…(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%

“…Due to concerns about increasing pneumococcal resistance to penicillin, and to provide coverage for atypical pathogens, the American Thoracic Society and Infectious Disease Society of America now recommend considering the use of a macrolide antibiotic plus high dose beta-lactam antibiotic for the empiric outpatient treatment of community acquired pneumonia. (1)(2)(3)(4) Recent surveillance studies of invasive pneumococcal isolates have demonstrated that only 73% of isolates remain susceptible to penicillin, and 78% susceptible to erythromycin. (5) The use of low dosages and long treatment duration with beta-lactam antibiotics have been identified as risk factors for the nasopharyngeal carriage of penicillin resistant organisms.…”

Section: Introductionmentioning

confidence: 99%

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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“…1,2 The rapid increase in resistance among common bacterial pathogens, such as Streptococcus pneumoniae, [3][4][5][6] is widely believed to be fueled by high rates of antibiotic use, much of which is unnecessary. [7][8][9][10][11] Because of the communicability of bacterial pathogens, the consequences of resis-tance have an impact on communities in addition to individual carriers.…”

mentioning

confidence: 99%

Impact of a 16-Community Trial to Promote Judicious Antibiotic Use in Massachusetts

et al. 2008

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OBJECTIVES. Reducing unnecessary antibiotic use, particularly among children, continues to be a public health priority. Previous intervention studies have been limited by size or design and have shown mixed results. The objective of this study was to determine the impact of a multifaceted, community-wide intervention on overall antibiotic use for young children and on use of broad-spectrum agents. In addition, we sought to compare the intervention's impact on commercially and Medicaid-insured children. METHODS. We conducted a controlled, community-level, cluster-randomized trial in 16 nonoverlapping Massachusetts communities, studied from 1998 to 2003. During 3 years, we implemented a physician behavior-change strategy that included guideline dissemination, small-group education, frequent updates and educational materials, and prescribing feedback. Parents received educational materials by mail and in primary care practices, pharmacies, and child care settings. Using health-plan data, we measured changes in antibiotics dispensed per person-year of observation among children who were aged 3 to <72 months, resided in study communities, and were insured by a participating commercial health plan or Medicaid. RESULTS. The data include 223135 person-years of observation. Antibiotic-use rates at baseline were 2.8, 1.7, and 1.4 antibiotics per person-year among those aged 3 to <24, 24 to <48, and 48 to <72 months, respectively. We observed a substantial downward trend in antibiotic prescribing, even in the absence of intervention. The intervention had no additional effect among children aged 3 to <24 months but was responsible for a 4.2% decrease among those aged 24 to <48 months and a 6.7% decrease among those aged 48 to <72 months. The intervention effect was greater among Medicaid-insured children and for broad-spectrum agents. CONCLUSIONS. A sustained, multifaceted, community-level intervention was only modestly successful at decreasing overall antibiotic use beyond substantial secular trends. The more robust impact among Medicaid-insured children and for specific medication classes provides an argument for specific targeting of resources for patient and physician behavior change.

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Macrolide Resistance Among Invasive <EMPH TYPE="ITAL">Streptococcus pneumoniae</EMPH> Isolates

Abstract: In the setting of increasing macrolide use, pneumococcal resistance has become common. Most resistant strains have MICs in the range in which treatment failures have been reported. Further study and surveillance are critical to understanding the clinical implications of our findings.

Cited by 289 publications

References 32 publications

Prevalence of serotypes and antimicrobial resistance of invasive strains of pneumococcus in children: analysis of 9 years

Prevalence of serotypes and antimicrobial resistance of invasive strains of pneumococcus in children: analysis of 9 years

Factors Associated With Antimicrobial Resistance and Mortality in Pneumococcal Bacteremia

Impact of a 16-Community Trial to Promote Judicious Antibiotic Use in Massachusetts

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