Community-acquired pneumonia in North American emergency departments: drug resistance and treatment success with clarithromycin
  • Brian H. Rowe , University of Alberta Hospital
  • Sam G. Campbell , Queen Elizabeth Hospital II
  • Edwin D. Boudreaux , University of Massachusetts Medical School
  • Ian Colman , University of Cambridge
  • Riyad B. Abu-Laban , Vancouver General Hospital
  • Marco L.A. Sivilotti , Queen's University
  • Sunday Clark , Harvard Medical School
  • Carlos A. Camargo , Jr. , Harvard Medical School
Article
UMMS Affiliation
Department of Emergency Medicine
Date
5-5-2007
Document Type
Article
Medical Subject Headings
Adult; Aged; Anti-Bacterial Agents; Clarithromycin; Community-Acquired Infections; Drug Resistance, Bacterial; Emergency Service, Hospital; Female; Humans; Male; Middle Aged; North America; Pneumonia; Prospective Studies; Sputum; Streptococcus pneumoniae
Disciplines
Abstract

BACKGROUND: Limited information on antibiotic resistance of Streptococcus pneumoniae (SP) exists for patients discharged from emergency departments with community-acquired pneumonia.

OBJECTIVES: Using a standardized collection process, this study examined sputum microbiology in outpatient community-acquired pneumonia.

METHODS: This was a multicenter, prospective cohort study conducted in North American emergency departments between December 2001 and May 2003. Thirty-one emergency departments enrolled patients older than 18 years with a Pneumonia Severity Index of I to III. All patients received oral clarithromycin and were followed up for four weeks. SP resistance to macrolides and penicillin was determined by a central laboratory.

RESULTS: Among the 317 cultured sputum samples, 116 (37%; 95% confidence interval [CI] = 32% to 42%) grew an identifiable organism; 74 (23% of cultured cases; 95% CI = 19% to 28%) grew non-SP organisms and 42 grew SP organisms (SP positive; 13% of cultured cases; 95% CI = 10% to 17%). A total of 13 resistant organisms (4% of cultured cases; 95% CI = 2% to 6%) were identified. Resistance to macrolides occurred in nine patients (3% of cultured cases [95% CI = 1% to 5%]; 24% of SP-positive cases [95% CI = 11% to 37%]); and resistance to penicillin occurred in nine patients (3% of all sputum-positive cases [95% CI = 1% to 5%]; 21% of SP-positive cases [95% CI = 9% to 34%]). The four-week cure rates were similar in both groups.

CONCLUSIONS: Among outpatients with community-acquired pneumonia, half produced adequate sputum samples and most were culture negative. SP resistance was similar to rates from large national databases, and results were of little (if any) consequence. In low-risk Pneumonia Severity Index cases, sputum cultures should not be collected routinely.

Rights and Permissions
Citation: Acad Emerg Med. 2007 Jul;14(7):607-15. Epub 2007 May 3. Link to article on publisher's site
Comments

At the time of publication, Edwin Boudreaux was not yet affiliated with the University of Massachusetts Medical School.

Related Resources
Link to Article in PubMed
Citation Information
Brian H. Rowe, Sam G. Campbell, Edwin D. Boudreaux, Ian Colman, et al.. "Community-acquired pneumonia in North American emergency departments: drug resistance and treatment success with clarithromycin" Vol. 14 Iss. 7
Available at: http://works.bepress.com/edwin_boudreaux/52/