RESPIRATORY Medicine / Pulmonology Updates
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پستهای کانال
[Editorial] The far-reaching effects of wildfire smoke
https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00256-0/fulltext?rss=yes
The 2025 European State of the Climate report identified Europe as the world's fastest-warming continent, surpassed only by the Arctic region. In 2026, successive heatwaves have contributed to severe droughts and historic wildfires, with France and Spain battling huge blazes in July as more than 300 000 people were forced from their homes. As of Aug 5, 2026, more than 1500 landscape fires had been detected across the EU since the start of the year, with nearly 500 000 hectares burnt. Beyond the immediate dangers for people living and working close to the flames are the far-reaching effects of wildfire smoke.
| 2 | [Articles] Crizotinib versus observation or placebo for surgically resected early-stage ALK-positive non-small-cell lung cancer (Eastern Cooperative Oncology Group–American College of Radiology Imaging Network E4512): a phase 3 trial
https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00192-X/fulltext?rss=yes
Adjuvant crizotinib does not prolong DFS in patients with surgically resected ALK-positive NSCLC. These findings suggest that crizotinib should not be recommended as an adjuvant therapy for patients with resected ALK-positive NSCLC. | 170 |
| 3 | [Comment] In the era of adjuvant alectinib, what can we learn from the E4512 trial of adjuvant crizotinib?
https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00231-6/fulltext?rss=yes
The phase 3 ECOG-ACRIN E4512 trial did not find a benefit in disease-free survival (DFS) with 2 years of adjuvant crizotinib compared with observation in patients with resected ALK-positive non-small-cell lung cancer (NSCLC).1 Although the study did not meet its primary endpoint, E4512 offers important lessons for future adjuvant trials in populations with molecularly defined lung cancer. | 156 |
| 4 | [Correspondence] Identifying the residual unmet need in severe asthma
https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00255-9/fulltext?rss=yes
The biologic treatments approved for the management of severe asthma have transformed the outlook for patients over the past decade. Each novel therapy has offered the opportunity for oral steroid-free asthma control and, for many patients, the possibility of clinical remission. Although anti-IgE proved effective for some patients, the development of targeted therapies against eosinophils soon appeared to be the paradigm shift. These anti-IL5 (mepolizumab) and anti-IL5R (benralizumab) biologics were soon followed by equally effective approaches targeting other components of T2 inflammation, namely those mediated via the IL-4 receptor (targeted by dupilumab) and those downstream of the epithelial alarmin TSLP (inhibited by tezepelumab). | 160 |
| 5 | [Articles] Symptom burden to characterise, predict, and prevent asthma attacks: a patient-level meta-analysis of randomised trials and translational prospective studies
https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00150-5/fulltext?rss=yes
In a large, individual patient-level meta-analysis of randomised controlled trials and translational prospective observational cohort studies, we observed little alignment of symptom burden with other clinical, physiological, or biological features of asthma and modest prognostic value for severe attacks. Conversely, type 2 biomarkers more reliably identified patients at high risk and those likely to respond to treatment. Symptoms might require contextual interpretation to guide anti-inflammatory escalation in asthma. | 339 |
| 6 | [Spotlight] Breathing Space: “A love letter to breath”
https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00254-7/fulltext?rss=yes
It has been nearly 10 years since Havi Carel's Spotlight in The Lancet Respiratory Medicine on breathlessness and the rift between objective measurement and subjective experience. Havi's phenomenological study of breathlessness for the Wellcome-funded medical humanities Life of Breath project (2015–20) did so much to highlight the entangled nature of breathlessness as a sensory-perceptual, cognitive-affective, relational, social, and existential/spiritual experience, which cannot be flattened into a lungs-brain “problem”. | 368 |
| 7 | [Articles] Mepolizumab effectiveness for patients with severe, uncontrolled chronic rhinosinusitis with nasal polyps in Italy (MEPOREAL): a real-life, multicentre, phase 4 trial
https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00197-9/fulltext?rss=yes
Mepolizumab progressively improved outcomes during the first 12 months of treatment. Long-term, prospective studies are warranted to further elucidate the rate of remission and control after 12 months. | 369 |
| 8 | [Spotlight] Edinburgh Festival Fringe: “Cancer isn't pretty—and neither is opera”
https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00261-4/fulltext?rss=yes
Cancer is often about numbers: the ups and downs of protein, hormone, or other tumour markers; the number of weeks of chemotherapy or radiotherapy that a patient must face; the number of months or years given as an estimated length of survival during a prognosis. Yet cancer is also about emotions: anger, fear, grief, and even hope. Katy Lees, a professional soprano, brought those emotions to life beautifully during Breathe: Five Arias That Saved My Life, her autobiographical one-woman debut show at the Edinburgh Festival Fringe, the world's biggest arts festival, which is taking place in Edinburgh, UK, on Aug 7–31. | 346 |
| 9 | Effects of ambient air pollution exposure on lung function in cystic fibrosis: old stories or breaking news?
http://thorax.bmj.com/cgi/content/short/81/9/821?rss=1
Ambient air pollution has short- and long-term adverse effects on health and increases morbidity and mortality in the general population.1–3 The association between air pollution and health is complex. Fluctuating pollutant concentration levels, timing of exposures and interaction between exposures and among host and environment contribute.4 Large environment-wide association studies are underway to capture the full ‘exposome’ picture.5 From a respiratory health perspective, pregnancy and early childhood are considered vulnerable time windows of lung development.6 7 The impact of host factors such as rare chronic lung diseases, for example, cystic fibrosis (CF), on the association between ambient air pollution exposure and respiratory health, is less established.8 CF is an inherited monogenic disorder leading to progressive muco-obstructive lung disease. Environmental exposures such as infection with Pseudomonas aeruginosa (P. aeruginosa) contribute to lung disease progression.... | 472 |
| 10 | Global asthma and pest control: bugs and WASPs
http://thorax.bmj.com/cgi/content/short/81/9/834?rss=1
Asthma affects over 300 million people worldwide and is the most common chronic lung disease in children, causing major global morbidity and mortality reflected in its inclusion in the WHO Global Action Plan1 and the United Nations 2030 Agenda.2 Asthma is driven by a person’s genetic susceptibility and immune response influenced by environmental exposure to pollutants and pathogens and modified by treatment interventions. These interactions occur over a life course with external exposures varying over time, such as acute infection, while the microenvironment or airway ecology can be persistently altered in disease. Asthma is consequently heterogeneous in terms of inflammatory profile, disordered airway physiology and symptoms.3 This heterogeneity is highlighted in the use of biologic therapies targeting specific phenotypes such as T2-high eosinophilic and allergic asthma. The mechanisms underlying T2-low and neutrophilic asthma remain less well defined and may in part involve airway microbial... | 334 |
| 11 | Significance of diffusing capacity of the lungs for carbon monoxide on chronic thromboembolic pulmonary hypertension
http://thorax.bmj.com/cgi/content/short/81/9/913?rss=1
Reduced diffusing capacity of the lungs for carbon monoxide (DLco) reflects microvasculopathy in chronic thromboembolic pulmonary hypertension, yet its clinical value is uncertain. In a Japanese nationwide registry (2018–2023) we studied 1270 patients: 486 formed an event cohort and 299 a treatment cohort who underwent pulmonary endarterectomy or balloon pulmonary angioplasty. Lower baseline DLco was indicative of smaller postprocedural improvements in mean pulmonary artery pressure, pulmonary vascular resistance and cardiac index (all p≤0.023) and a higher risk of clinical events (HR 0.971, p=0.005). Outcomes deteriorated below 59.6%, indicating DLco may help stratify prognosis and treatment benefit. | 274 |
| 12 | Smoking cessation within lung cancer screening: how much more evidence is needed?
http://thorax.bmj.com/cgi/content/short/81/9/830?rss=1
Low-dose CT (LDCT) screening has transformed lung cancer outcomes by enabling earlier diagnosis and reducing mortality among individuals at high risk.1 2 As programmes expand internationally, their reach continues to grow. However, screening alone cannot address the primary cause of lung cancer. Integrating effective smoking cessation support into lung cancer screening represents one of the most important opportunities to maximise the preventive impact of these programmes. Screening encounters offer a powerful ‘teachable moment’ for smoking cessation. Individuals undergoing lung cancer screening are typically long-term smokers at high risk of tobacco-related disease and may be particularly receptive to behaviour change during this process. However, screening alone does not reliably prompt cessation. Evidence increasingly shows that quit rates improve when cessation support is systematically embedded within screening pathways, rather than delivered through passive referral to external services. Randomised trials consistently demonstrate that structured behavioural counselling combined with... | 246 |
| 13 | Beyond detection: what happens after lung cancer screening matters more
http://thorax.bmj.com/cgi/content/short/81/9/832?rss=1
Lung cancer screening (LCS) with low-dose CT (LDCT) aims to reduce lung cancer-related mortality.1 2 This benefit is achieved by detecting lung cancer at an asymptomatic, early stage, thereby enabling curative-intent treatments such as surgical resection or stereotactic radiotherapy. However, among the many nodules detected through LDCT screening, only a small proportion ultimately turn out to be lung cancer (3.6% in the National Lung Screening Trial).1 Consequently, distinguishing malignant from benign nodules forms a critical challenge of any effective LCS programme. Current LCS programmes generally incorporate longitudinal LDCT surveillance, additional imaging modalities such as contrast-enhanced CT and positron emission tomography, and invasive tissue sampling when indicated.3 Although imaging surveillance is often necessary to observe nodule behaviour over time and to identify progression warranting further intervention, this period of ‘watchful waiting’ may delay diagnostic work-up and raise concern about missing the optimal... | 195 |
| 14 | 'Mind the gap
http://thorax.bmj.com/cgi/content/short/81/9/828?rss=1
Sleep and public health Sleep has been surrounded by mythical beliefs since ancient times. However, when it comes to an assessment of health, sleep has typically been neglected.1 With advances in technology in the 20th century, that led to our current understanding of sleep stages, came an increasing evidence base for sleep medicine. By now, it has been added to the ‘Life’s Essential 8’, as described by the American Heart Association.2 Sleep duration and sleep quality matter; sleep does not only provide rest for mind and body, it is associated with quality of life and symptoms, improved hard clinical outcomes, including the metabolic, cardiovascular and neurological systems, and sleep conditions also impact the overall and cardiovascular mortality, and the treatment of sleep disorders can improve survival.3 4 Despite our current knowledge base, data on population-based sleep outcomes remain sparse, | 165 |
| 15 | A long time ago, in an airway far, far away: early changes in the proximal airways in IPF and their response to drug treatment
http://thorax.bmj.com/cgi/content/short/81/9/825?rss=1
Idiopathic pulmonary fibrosis (IPF) is a progressive fibrosing lung disease characterised by irreversible remodelling of the distal lung and loss of respiratory function. Current models centre alveolar epithelial progenitor dysfunction in pathogenesis, with injured epithelial cells exhibiting deregulated stress responses and impaired differentiation, compromising effective regeneration.1 Recent single-cell studies highlight persistent transitional epithelial states and the emergence of aberrant basaloid cells, consistent with stalled or maladaptive repair.2 3 Epithelial dysfunction is closely linked to mesenchymal activation through dysregulated epithelial-mesenchymal cross-talk, promoting fibroblast expansion, excessive extracellular matrix deposition and progressive architectural distortion.4 Since the aberrant basaloid cell first appeared as a potential disease driver, debate has centred on its origins. Are alveolar type 2 progenitors undergoing a stress-triggered identity shift? Or are bronchiolar cells, well-meaning but ill-equipped, sweeping in to compensate for lost alveolar regenerative capacity, only to exacerbate injury? Multiple lines... | 180 |
| 16 | Creating certainty in uncertainty: improving spirometry interpretation
http://thorax.bmj.com/cgi/content/short/81/9/823?rss=1
For those of us writing pulmonary function reports, how many times have we been in the situation where the results are at, or just above, or just below, the lower limit of normal? Too often, the person writing the report must make a judgement with very limited information and then write a report that is meaningful, and indeed helpful, to the clinician who requested the test. This line in the sand of normal versus abnormal, used since the beginning of time, is really a non-sense, especially with the many known factors that influence lung development that have lifelong impact on respiratory health.1 Indeed, for the example of spirometry, the forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) ratio could be within the normal range in a person with asthma,2 3 so what does ‘normal’ mean? Moreover, the recent issue of geographical ancestry | 168 |
| 17 | Upstaging of screen-detected lung cancers during diagnostic assessment
http://thorax.bmj.com/cgi/content/short/81/9/894?rss=1
Introduction
Lung cancer is the leading cause of cancer-related death worldwide. Low-dose CT (LDCT) screening improves outcomes by detecting early-stage cancers as pulmonary nodules. As most are benign, diagnosing these nodules is challenging and often requires surveillance imaging. The aim of this study is to assess the frequency of cancer progression in a lung cancer screening study as measured by tumour stage (T-stage).
Methods
SUMMIT is a prospective cohort study assessing implementation of lung cancer screening with LDCT in a high-risk population. Screen-detected lung cancers with clinical tumour stage cT1a–c at time of referral were included. Upstaging was defined as an increase in T-stage from referral to treatment. The date of death was obtained from the National Cancer Registration and Analysis Service. Cox proportional hazards analysis with adjustment for age, sex, Charlson Comorbidity Index and pack years was used to assess mortality between groups.
Results
390 screen-detected cancers were stage cT1a–c at time of referral. Upstaging occurred more frequently in cT1a (n=48, 56%) compared with cT1b (n=83, 38%) or cT1c (n=34, 40%), p=0.01. The proportion of part-solid nodules was similar between groups (upstaged-N=47, 27%, vs not upstaged-N=45, 21%, p=0.19). 43% of tumours increased T-stage from referral to first treatment (n=165). In participants upstaged, time from referral to treatment was longer (upstaged: 84 days, 46–298 vs not upstaged: 72 days, 43–211, p=0.04). Adjusted overall survival analyses showed an association between upstaging and mortality (HR 1.68, 95% CI 1.13 to 2.51, p=0.01).
Conclusion
Tumour upstaging occurred in nearly half of early-stage cases in a lung cancer screening population. Tumour upstaging was associated with longer time to treatment and poorer outcomes in this population.
Trial registration number
NCT03934866 (http://thorax.bmj.com/cgi/content/short/81/9/NCT03934866). | 161 |
| 18 | Never say die: making a death from asthma a never event
http://thorax.bmj.com/cgi/content/short/81/9/836?rss=1
Introduction Last year’s update on deaths due to asthma published by Asthma + Lung UK makes difficult reading.1 It states that four people die from asthma every day in the UK and that many more continue to be at risk, with tens of thousands admitted to hospital every year. The publication marked ten years since the 2014 National Review of Asthma Deaths which found that two thirds of asthma deaths were preventable and that key risk factors for death were overuse of reliever inhalers, underuse of preventer inhalers, and emergency hospital visits with no follow-up appointment.2 However, the top-level numbers hide significant nuance and the latest BTS/SIGN/NICE 3 guidance offers hope that the main risk factor, overuse of short-acting beta agonists allied to underuse of inhaled corticosteroids, will become less prevalent. Now may be the time to re-evaluate asthma deaths and consider... | 161 |
| 19 | Airway microbiota in young people across four continents differ by country, asthma status and inflammatory phenotype
http://thorax.bmj.com/cgi/content/short/81/9/903?rss=1
Background
Asthma is an umbrella diagnosis encompassing distinct pathophysiological mechanisms. While a global problem, our understanding of the interplay between respiratory microbiology and airway inflammation is largely from populations in high-income settings. As a result, treatment approaches align poorly with asthma characteristics in less studied populations.
Objective
To identify conserved and geographically distinct relationships between airway inflammation and microbiota characteristics in young people with and without asthma.
Methods
We conducted a cross-sectional study performing inflammatory phenotyping, microbiota analysis and enumeration of total bacteria, Haemophilus influenzae and Moraxella catarrhalis on 488 induced sputum samples from participants from Brazil (asthma: 68; non-asthma: 8), Ecuador (asthma: 89; non-asthma: 30), Uganda (asthma: 61; non-asthma: 8), New Zealand (asthma: 129; non-asthma: 58) and the UK (asthma: 25; non-asthma: 20). Microbiota characteristics were compared by country, asthma status and inflammatory characteristics, adjusting for age and sex.
Results
Asthma inflammatory phenotypes and microbiology differed between countries, with Uganda characterised by higher neutrophils, microbial diversity and bacterial abundance. Comparison of airway inflammation with microbiota characteristics showed conserved relationships across centres, with airway neutrophil proportion explaining variance in microbiota Bray-Curtis dissimilarity (pH. influenzae and M. catarrhalis load (all pStreptococcus abundance. Country-specific associations between airway inflammation and microbiology were evident.
Conclusion
Both airway inflammation and microbiology varied geographically in young people with asthma. Associations between microbiota characteristics and neutrophilic phenotype were conserved. | 144 |
| 20 | Assessment of macrolide resistance in the respiratory tract of preterm-born infants during treatment with azithromycin in the AZTEC clinical trial
http://thorax.bmj.com/cgi/content/short/81/9/838?rss=1
Background
Our multicentre, double-blind, randomised, placebo-controlled Azithromycin therapy for prevention of chronic lung disease of prematurity trial assessed if early 10-day azithromycin treatment improved survival without development of chronic lung disease of prematurity when compared with placebo in 796 preterm-born infants. Since antibiotic resistance remains a significant global health priority, we had preplanned macrolide-resistance assessment in recruited infants. We, therefore, identified baseline macrolide-resistant genes in respiratory samples and determined if this was altered by azithromycin treatment. Furthermore, we assessed if macrolide-resistant bacteria isolated from respiratory samples were also resistant to other common antibiotic classes.
Methods
Six common macrolide-resistant genes: erm(A), erm(B), erm(C), erm(F), mef(A/E) and msr(A) were identified by quantitative PCR (qPCR) from serial nasopharyngeal and endotracheal aspirates from recruited infants at baseline (pretreatment), day-5, day-10 and day-14 (post treatment). Azithromycin-resistant bacteria were assessed by culture in presence/absence of azithromycin and underlying resistance mechanisms were confirmed by qPCR. Resistance to other common antibiotics was also evaluated and molecular determinants were identified by whole genome sequencing.
Results
From 1108 (n=541 azithromycin, n=567 placebo) respiratory aspirates from 348 preterm infants, the overall prevalence of macrolide-resistant genes was similar in the placebo (63.7%) and azithromycin (63.9%) groups, with only erm(C) gene increased by azithromycin. Azithromycin-resistant bacteria were resistant to multiple clinically used antibiotics, being associated with several different underlying resistance mechanisms. Coagulase-negative staphylococci (CoNS) were the most recovered macrolide-resistant bacteria.
Conclusions
Macrolide-resistant genes were noticeably prevalent in the placebo group, with minimal increase with azithromycin treatment, suggesting that, regardless of the additional use of azithromycin, judicious use of antibiotics is required in preterm-born infants. | 173 |
