{
    "abstract": "Streptococcus pneumoniae, a primary cause of community-acquired pneumonia (CAP), is typically treated with \u03b2-lactams and macrolides or quinolones. Corticosteroids are now recommended as adjunctive therapy in severe CAP to improve outcomes. In this prospective randomized animal study, we evaluated the bactericidal efficacy of various antibiotic regimens combined with corticosteroids using a porcine pneumococcal pneumonia model.\nIn 30 White-Landrace female pigs, pneumonia was induced by intrabronchial inoculation of macrolide-resistant S. pneumoniae 19A isolate. Animals were randomized to receive saline, ceftriaxone (CRO) with levofloxacin (LVX), CRO with azithromycin (AZM), or combinations of these with methylprednisolone (MP). The primary outcome, S. pneumoniae concentrations in lung tissue after 48\u00a0h of treatment, showed that the CRO\u2009+\u2009LVX, CRO\u2009+\u2009AZM, CRO\u2009+\u2009LVX\u2009+\u2009MP, and CRO\u2009+\u2009AZM\u2009+\u2009MP groups were equally effective in reducing bacterial load. However, complete bacterial eradication from lung tissue was achieved only in the CRO\u2009+\u2009AZM\u2009+\u2009MP group. Secondary outcomes, including bacterial burden in tracheal aspirates and bronchoalveolar lavage (BAL) samples, showed similar bactericidal activity across all treatment groups. The CRO\u2009+\u2009AZM\u2009+\u2009MP group demonstrated the most controlled inflammatory response, achieving baseline levels of inflammation, while other groups exhibited elevated inflammatory markers.\nDespite using a macrolide-resistant S. pneumoniae isolate, the combination of CRO, AZM, and MP achieves similar or even superior results compared to other antibiotic combinations. This regimen provides both bactericidal and immunomodulatory benefits, suggesting its effectiveness in treating macrolide-resistant S. pneumoniae pneumonia.",
    "authors": [
        {
            "affiliation": "Pneumology Department, Hospital Cl\u00ednic, Thorax Institute, Barcelona, Spain.\nInstitut d'Investigacions Biom\u00e8diques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.\nUniversity of Barcelona, Barcelona, Spain.\nCentro de Investigaci\u00f3n Biomedica En Red- Enfermedades Respiratorias (CIBERES), Barcelona, Spain.\nUniversity of Nantes, Nantes, France.",
            "firstname": "Ana",
            "initials": "A",
            "lastname": "Motos"
        },
        {
            "affiliation": "Pneumology Department, Hospital Cl\u00ednic, Thorax Institute, Barcelona, Spain.\nInstitut d'Investigacions Biom\u00e8diques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.\nUniversity of Barcelona, Barcelona, Spain.\nDepartment of Infectious Diseases, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.",
            "firstname": "Minlan",
            "initials": "M",
            "lastname": "Yang"
        },
        {
            "affiliation": "Institut d'Investigacions Biom\u00e8diques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.\nAnesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.",
            "firstname": "Denise",
            "initials": "D",
            "lastname": "Battaglini"
        },
        {
            "affiliation": "Pneumology Department, Hospital Cl\u00ednic, Thorax Institute, Barcelona, Spain.\nInstitut d'Investigacions Biom\u00e8diques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.\nUniversity of Barcelona, Barcelona, Spain.\nDepartment of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China.",
            "firstname": "Hua",
            "initials": "H",
            "lastname": "Yang"
        },
        {
            "affiliation": "Institut d'Investigacions Biom\u00e8diques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.\nFondazione IRCCS C\u00e0 Granda Ospedale Maggiore Policlinico Internal Medicine Department, Respiratory Unit and Adult Cystic Fibrosis Center, and Department of Pathophysiology and Transplantation, Universit\u00e0 Degli Studi Di Milano, Milan, Italy.",
            "firstname": "Andrea",
            "initials": "A",
            "lastname": "Meli"
        },
        {
            "affiliation": "Institut d'Investigacions Biom\u00e8diques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.\nUniversity of Barcelona, Barcelona, Spain.\nDepartment of Cardiology, Erasmus MC, University Medical Center Rotterdam, 3015, Rotterdam, The Netherlands.",
            "firstname": "Joaquim",
            "initials": "J",
            "lastname": "Bobi"
        },
        {
            "affiliation": "Pneumology Department, Hospital Cl\u00ednic, Thorax Institute, Barcelona, Spain.\nInstitut d'Investigacions Biom\u00e8diques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.",
            "firstname": "Roberto",
            "initials": "R",
            "lastname": "Cabrera"
        },
        {
            "affiliation": "Institut d'Investigacions Biom\u00e8diques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.\nAnesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.",
            "firstname": "Giacomo",
            "initials": "G",
            "lastname": "Tanzella"
        },
        {
            "affiliation": "Institut d'Investigacions Biom\u00e8diques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.",
            "firstname": "Carmen Rosa",
            "initials": "CR",
            "lastname": "Vargas"
        },
        {
            "affiliation": "Pneumology Department, Hospital Cl\u00ednic, Thorax Institute, Barcelona, Spain.\nInstitut d'Investigacions Biom\u00e8diques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.\nUniversity of Barcelona, Barcelona, Spain.",
            "firstname": "Marta",
            "initials": "M",
            "lastname": "Arrieta"
        },
        {
            "affiliation": "Pneumology Department, Hospital Cl\u00ednic, Thorax Institute, Barcelona, Spain.\nInstitut d'Investigacions Biom\u00e8diques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.\nUniversity of Barcelona, Barcelona, Spain.",
            "firstname": "Blanca",
            "initials": "B",
            "lastname": "Llonch"
        },
        {
            "affiliation": "Pneumology Department, Hospital Cl\u00ednic, Thorax Institute, Barcelona, Spain.\nInstitut d'Investigacions Biom\u00e8diques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.",
            "firstname": "Nona",
            "initials": "N",
            "lastname": "Rovira-Ribalta"
        },
        {
            "affiliation": "Institut d'Investigacions Biom\u00e8diques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.\nUniversity of Barcelona, Barcelona, Spain.\nCentro de Investigaci\u00f3n Biomedica En Red- Enfermedades Respiratorias (CIBERES), Barcelona, Spain.\nSurgical Intensive Care Unit, Hospital Cl\u00ednic de Barcelona, Barcelona, Spain.",
            "firstname": "Enric",
            "initials": "E",
            "lastname": "Barbeta"
        },
        {
            "affiliation": "Institut d'Investigacions Biom\u00e8diques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.\nDepartment of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Chieti, Italy.",
            "firstname": "Pierluigi",
            "initials": "P",
            "lastname": "di Giannatale"
        },
        {
            "affiliation": "Institut d'Investigacions Biom\u00e8diques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.\nAnesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.",
            "firstname": "Stefano",
            "initials": "S",
            "lastname": "Nogas"
        },
        {
            "affiliation": "Pneumology Department, Hospital Cl\u00ednic, Thorax Institute, Barcelona, Spain.\nInstitut d'Investigacions Biom\u00e8diques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.\nUniversity of Barcelona, Barcelona, Spain.\nCentro de Investigaci\u00f3n Biomedica En Red- Enfermedades Respiratorias (CIBERES), Barcelona, Spain.",
            "firstname": "Laia",
            "initials": "L",
            "lastname": "Fern\u00e1ndez-Barat"
        },
        {
            "affiliation": "Institut d'Investigacions Biom\u00e8diques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.\nUniversity of Barcelona, Barcelona, Spain.",
            "firstname": "Montserrat",
            "initials": "M",
            "lastname": "Rigol"
        },
        {
            "affiliation": "Pneumology Department, Hospital Cl\u00ednic, Thorax Institute, Barcelona, Spain.\nInstitut d'Investigacions Biom\u00e8diques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.\nUniversity of Barcelona, Barcelona, Spain.",
            "firstname": "Kasra",
            "initials": "K",
            "lastname": "Kiarostami"
        },
        {
            "affiliation": "Institut d'Investigacions Biom\u00e8diques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.\nCentro de Investigaci\u00f3n Biomedica En Red- Enfermedades Respiratorias (CIBERES), Barcelona, Spain.\nDepartment of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, James's Street, Dublin, D08 NHY1, Ireland.",
            "firstname": "Ignacio",
            "initials": "I",
            "lastname": "Mart\u00edn-Loeches"
        },
        {
            "affiliation": "University of Barcelona, Barcelona, Spain.\nISGlobal, Hospital Cl\u00ednic-Universitat de Barcelona, Barcelona, Spain.\nDepartment of Clinical Microbiology, Centre for Biomedical Diagnosis, Hospital Cl\u00ednic, Barcelona, Spain.\nCentro de Investigaci\u00f3n Biom\u00e9dica En Red- Enfermedades Infecciosas (CIBERINFEC), Barcelona, Spain.",
            "firstname": "Jordi",
            "initials": "J",
            "lastname": "Vila"
        },
        {
            "affiliation": "University of Barcelona, Barcelona, Spain.\nDepartment of Pathology, Hospital Clinic, Barcelona, Spain.",
            "firstname": "Daniel",
            "initials": "D",
            "lastname": "Martinez"
        },
        {
            "affiliation": "Critical Care Research Group, The Prince Charles Hospital, Chermside, QLD, Australia.\nUniversity of Queensland, St Lucia, QLD, Australia.\nQueensland University of Technology, Kelving Grove, QLD, Australia.\nThe Wesley Medical Research, Auchenflower, QLD, Australia.",
            "firstname": "Gianluigi Li",
            "initials": "GL",
            "lastname": "Bassi"
        },
        {
            "affiliation": "Pneumology Department, Hospital Cl\u00ednic, Thorax Institute, Barcelona, Spain. atorres@ub.edu.\nInstitut d'Investigacions Biom\u00e8diques August Pi I Sunyer (IDIBAPS), Barcelona, Spain. atorres@ub.edu.\nUniversity of Barcelona, Barcelona, Spain. atorres@ub.edu.\nCentro de Investigaci\u00f3n Biomedica En Red- Enfermedades Respiratorias (CIBERES), Barcelona, Spain. atorres@ub.edu.\nServei de Pneumologia I Al\u2022L\u00e8rgia Respiratoria, Hospital Cl\u00ednic, Calle Villarroel 170, Esc 6/8 Planta 2, 08036, Barcelona, Spain. atorres@ub.edu.",
            "firstname": "Antoni",
            "initials": "A",
            "lastname": "Torres"
        }
    ],
    "conclusions": null,
    "copyrights": "\u00a9 2025. The Author(s).",
    "doi": "10.1186/s40635-025-00731-1",
    "journal": "Intensive care medicine experimental",
    "keywords": [
        "Streptococcus pneumoniae",
        "Animal model",
        "Combination antibiotics therapy",
        "Community-acquired pneumonia",
        "Corticosteroids",
        "Mechanical ventilation",
        "Severe pneumonia"
    ],
    "methods": null,
    "publication_date": "2025-02-28",
    "pubmed_id": "40016489\n30243584\n20729232\n24000245\n24690444\n37012080\n38184008\n28890434\n20595152\n22855392\n25608756\n25688779\n36942789\n29347874\n20525247\n23371407\n20889284\n34675433\n19225097\n24618700\n21531958\n7767535\n35561318\n3512509\n20351024\n18768577\n19953222\n17278083\n15728935\n17709460\n20610825\n11023483\n22190609\n26344609\n15735416\n38240492\n20398732\n29236286\n2061872\n28617807\n23319420\n32959980\n11751983\n3911709\n38807178\n18508831\n30575845\n27741949\n31704213",
    "results": "In 30 White-Landrace female pigs, pneumonia was induced by intrabronchial inoculation of macrolide-resistant S. pneumoniae 19A isolate. Animals were randomized to receive saline, ceftriaxone (CRO) with levofloxacin (LVX), CRO with azithromycin (AZM), or combinations of these with methylprednisolone (MP). The primary outcome, S. pneumoniae concentrations in lung tissue after 48\u00a0h of treatment, showed that the CRO\u2009+\u2009LVX, CRO\u2009+\u2009AZM, CRO\u2009+\u2009LVX\u2009+\u2009MP, and CRO\u2009+\u2009AZM\u2009+\u2009MP groups were equally effective in reducing bacterial load. However, complete bacterial eradication from lung tissue was achieved only in the CRO\u2009+\u2009AZM\u2009+\u2009MP group. Secondary outcomes, including bacterial burden in tracheal aspirates and bronchoalveolar lavage (BAL) samples, showed similar bactericidal activity across all treatment groups. The CRO\u2009+\u2009AZM\u2009+\u2009MP group demonstrated the most controlled inflammatory response, achieving baseline levels of inflammation, while other groups exhibited elevated inflammatory markers.",
    "title": "Corticosteroid and antimicrobial therapy in macrolide-resistant pneumococcal pneumonia porcine model.",
    "xml": "<Element 'PubmedArticle' at 0x788505589080>"
}