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Volume 12, Number 8—August 2006

Research

Macrolide Resistance in Adults with Bacteremic Pneumococcal Pneumonia

Joshua P. Metlay*†Comments to Author , Neil O. Fishman†, Marshall M. Joffe†, Michael J. Kallan†, Jesse L. Chittams†, and Paul H. Edelstein†
Author affiliations: *Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA; †University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA

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Table 2

Patterns of prior antimicrobial drug exposure for patients and controls*

Antimicrobial agent exposure Macrolide resistant, n = 76 (%) Macrolide susceptible, n = 368 (%) OR 95% CI p value
Any in prior 6 mo† 34 (45) 101 (27) 2.2 1.3–3.7 0.002
Any macrolide in prior 6 mo 14 (19) 29 (8) 2.7 1.3–5.4 0.004
Any quinolone in prior 6 mo 14 (19) 33 (9) 2.3 1.2–4.6 0.013
Any penicillin in prior 6 mo 8 (11) 36 (10) 1.1 0.5–2.5 0.81
Any cephalosporin in prior 6 mo 4 (5) 15 (4) 1.3 0.4–4.1 0.62
Any tetracycline in prior 6 mo 1 (1) 3 (1) 1.6 0.2–16.1 0.66
No. antimicrobial agents in 6 mo
None 41 (55) 261 (71) Referent
1 prescription 18 (24) 75 (20) 1.5 0.8–2.7 0.20
>2 prescriptions 16 (21) 33 (9) 3.0 1.5–6.0 0.002
Did not complete last prescription 9 (12) 14 (4) 3.5 1.4–8.3 0.004
On antimicrobial agent at admission 4 (5) 7 (2) 2.9 0.8–10.2 0.083
Time since antimicrobial agent‡
No prior drug use 44 (59) 277 (75) Referent
<3 mo 22 (29) 62 (17) 2.2 1.2–4.2 0.006
4–6 mo 9 (12) 30 (8) 1.7 0.8–4.5 0.12

*Odds ratio (OR) and 95% binomial confidence interval (95% CI). P value based on χ2 test.
†Does not include antimicrobial agents that patient was taking at time of admission for bacteremic pneumococcal pneumonia.
‡For patients on >1 antimicrobial agent in previous 6 months, this represents time since most recent course of drugs.

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