title: Macrolide resistance in adults with bacteremic pneumococcal pneumonia.
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).
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, Philadelphia Veterans Affairs Medical Center, 423 Guardian Drive, Philadelphia, PA 19104, USA. jmetlay@cceb.med.upenn.edu
authors.forename: Joshua P
authors.initials: JP
authors.lastname: Metlay
authors.forename: Neil O
authors.initials: NO
authors.lastname: Fishman
authors.forename: Marshall M
authors.initials: MM
authors.lastname: Joffe
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Kallan
authors.forename: Jesse L
authors.initials: JL
authors.lastname: Chittams
authors.forename: Paul H
authors.initials: PH
authors.lastname: Edelstein
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology; D016022:Case-Control Studies; D024881:Drug Resistance, Bacterial; D005260:Female; D006760:Hospitalization; D006801:Humans; D007407:Interviews as Topic; D018942:Macrolides / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania / Q000453:epidemiology; D011018:Pneumonia, Pneumococcal / Q000453:epidemiology* / Q000382:microbiology; D011159:Population Surveillance; D012307:Risk Factors; D013296:Streptococcus pneumoniae / Q000187:drug effects*
chemical_list: D000900:Anti-Bacterial Agents; D018942:Macrolides