000			03053nam a22003617a 4500
008			210217s20212021 xxu||||| |||| 00| 0 eng d
022			_a0954-6111
024			_a10.1016/j.rmed.2021.106307 [doi]
024			_aS0954-6111(21)00013-5 [pii]
040			_aOvid MEDLINE(R)
099			_a33486205
245			_aPneumococal community-acquired pneumonia in the intensive care unit: Azithromycin remains protective despite macrolide resistance.
251			_aRespiratory Medicine. 177:106307, 2021 Jan 08.
252			_aRespir Med. 177:106307, 2021 Jan 08.
253			_aRespiratory medicine
260			_c2021
260			_fFY2021
265			_saheadofprint
266			_d2021-02-17
520			_aBACKGROUND: 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.
520			_aCONCLUSIONS: 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. Copyright (c) 2021 Elsevier Ltd. All rights reserved.
520			_aMETHODS: 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.
520			_aRESULTS: 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.
546			_aEnglish
650			_aIN PROCESS -- NOT YET INDEXED
651			_aMedStar Washington Hospital Center
656			_aMedicine/Pulmonary-Critical Care
657			_aJournal Article
700			_aShorr, Andrew F
790			_aHampton N, Kollef MH, Micek ST, Shorr AF, Simmons J
856			_uhttps://dx.doi.org/10.1016/j.rmed.2021.106307 _zhttps://dx.doi.org/10.1016/j.rmed.2021.106307
942			_cART _dArticle
999			_c6014 _d6014