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Nasopharyngeal carriage and macrolide resistance in Indigenous children with bronchiectasis randomized to long-term azithromycin or placebo

Overview of attention for article published in European Journal of Clinical Microbiology & Infectious Diseases, September 2015
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Title
Nasopharyngeal carriage and macrolide resistance in Indigenous children with bronchiectasis randomized to long-term azithromycin or placebo
Published in
European Journal of Clinical Microbiology & Infectious Diseases, September 2015
DOI 10.1007/s10096-015-2480-0
Pubmed ID
Authors

K. M. Hare, K. Grimwood, A. B. Chang, M. D. Chatfield, P. C. Valery, A. J. Leach, H. C. Smith-Vaughan, P. S. Morris, C. A. Byrnes, P. J. Torzillo, A. C. Cheng

Abstract

Although long-term azithromycin decreases exacerbation frequency in bronchiectasis, increased macrolide resistance is concerning. We investigated macrolide resistance determinants in a secondary analysis of a multicenter randomized controlled trial. Indigenous Australian children living in remote regions and urban New Zealand Māori and Pacific Islander children with bronchiectasis were randomized to weekly azithromycin (30 mg/kg) or placebo for up to 24 months and followed post-intervention for up to 12 months. Nurses administered and recorded medications given and collected nasopharyngeal swabs 3-6 monthly for culture and antimicrobial susceptibility testing. Nasopharyngeal carriage of Haemophilus influenzae and Moraxella catarrhalis was significantly lower in azithromycin compared to placebo groups, while macrolide-resistant Streptococcus pneumoniae and Staphylococcus aureus carriage was significantly higher. Australian children, compared to New Zealand children, had higher carriage overall, significantly higher carriage of macrolide-resistant bacteria at baseline (16/38 versus 2/40 children) and during the intervention (69/152 versus 22/239 swabs), and lower mean adherence to study medication (63 % versus 92 %). Adherence ≥70 % (versus <70 %) in the Australian azithromycin group was associated with lower carriage of any pathogen [odds ratio (OR) 0.19, 95 % confidence interval (CI) 0.07-0.53] and fewer macrolide-resistant pathogens (OR 0.34, 95 % CI 0.14-0.81). Post-intervention (median 6 months), macrolide resistance in S. pneumoniae declined significantly in the azithromycin group, from 79 % (11/14) to 7 % (1/14) of positive swabs, but S. aureus strains remained 100 % macrolide resistant. Azithromycin treatment, the Australian remote setting, and adherence <70 % were significant independent determinants of macrolide resistance in children with bronchiectasis. Adherence to treatment may limit macrolide resistance by suppressing carriage.

Twitter Demographics

The data shown below were collected from the profile of 1 tweeter who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 67 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 67 100%

Demographic breakdown

Readers by professional status Count As %
Student > Master 10 15%
Student > Bachelor 9 13%
Researcher 7 10%
Student > Ph. D. Student 7 10%
Student > Postgraduate 5 7%
Other 17 25%
Unknown 12 18%
Readers by discipline Count As %
Medicine and Dentistry 26 39%
Nursing and Health Professions 8 12%
Agricultural and Biological Sciences 4 6%
Biochemistry, Genetics and Molecular Biology 3 4%
Pharmacology, Toxicology and Pharmaceutical Science 2 3%
Other 7 10%
Unknown 17 25%

Attention Score in Context

This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 14 September 2015.
All research outputs
#9,769,734
of 12,226,394 outputs
Outputs from European Journal of Clinical Microbiology & Infectious Diseases
#1,379
of 1,790 outputs
Outputs of similar age
#166,784
of 241,375 outputs
Outputs of similar age from European Journal of Clinical Microbiology & Infectious Diseases
#40
of 75 outputs
Altmetric has tracked 12,226,394 research outputs across all sources so far. This one is in the 11th percentile – i.e., 11% of other outputs scored the same or lower than it.
So far Altmetric has tracked 1,790 research outputs from this source. They receive a mean Attention Score of 3.5. This one is in the 12th percentile – i.e., 12% of its peers scored the same or lower than it.
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We're also able to compare this research output to 75 others from the same source and published within six weeks on either side of this one. This one is in the 28th percentile – i.e., 28% of its contemporaries scored the same or lower than it.