Penicillin-resistant pneumococcus and risk of treatment failure in pneumonia (original) (raw)
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Clinical Infectious Diseases, 2004
High-level penicillin resistance has been associated with treatment failure in patients with Streptococcus pneumoniae infections. To identify a subgroup of patients at low risk for high-level penicillin-nonsusceptible S. pneumoniae bacteremia, a cross-sectional study of 303 patients was performed. For the total study population, penicillin resistance was observed in 98 (32%) of 303 patients; high-level resistance was seen in 33 (11%). A predictive model was created by using 3 baseline variables that were independently associated with high-level penicillin resistance: previous b-lactam antibiotic use, previous stay in a risk area (defined as stay in day care facilities, prisons, homeless shelters, nursing homes, or other long-term care facilities), and previous respiratory tract infection. The model was used to identify patients at low and high risk for high-level penicillin-resistant pneumococcal bacteremia. None of the isolates of patients in the low-risk subgroup had ceftriaxone resistance. Patients in the low-risk subgroup could be empirically treated with fluoroquinolone-sparing regimens.
Drug‐Resistant Pneumococcal Pneumonia: Clinical Relevance and Related Factors
Clinical Infectious Diseases, 2004
A multicenter study of 638 cases of community-acquired pneumonia due to Streptococcus pneumoniae (SP-CAP) was performed to assess current levels of resistance. Of the pneumococcal strains, 35.7% had an minimum inhibitory concentration (MIC) of penicillin of у0.12 mg/mL (3 isolates had an MIC of 4 mg/mL), 23.8% had an MIC of erythromycin of 128 mg/mL, and 22.2% were multidrug resistant. Logistic regression determined that chronic pulmonary disease (odds ratio [OR], 1.44], human immunodeficiency virus infection (OR, 1.98), clinically suspected aspiration (OR, 2.12), and previous hospital admission (OR, 1.69) were related to decreased susceptibility to penicillin, and previous admission (OR, 1.89) and an MIC of penicillin of MIC у0.12 mg/mL (OR, 15.85) were related to erythromycin resistance (MIC, у1 mg/mL). The overall mortality rate was 14.4%. Disseminated intravascular coagulation, empyema, and bacteremia were significantly more frequent among patients with penicillin-susceptible SP-CAP. Among isolates with MICs of penicillin of у0.12 mg/mL, serotype 19 was predominant and was associated with a higher mortality rate. In summary, the rate of resistance to b-lactams and macrolides among S. pneumoniae that cause CAP remains high, but such resistance does not result in increased morbidity. The increasing incidence of multiple-antimicrobial resistance among Streptococcus pneumoniae isolates is be
Clinical Infectious Diseases, 1997
Pneumococcal disease was studied prospectively to determine the risk factors associated with resistance to penicillin and other antibiotics. One hundred twelve clinically significant pneumococcal isolates were recovered from 95 patients. Approximately one-half (49.47%) of the cases were due to penicillin-resistant strains. Multivariate analysis showed that previous use of b-lactam antibiotics (odds ratio [OR], 2.81; 95% confidence interval [CI], 0.95-8.27), alcoholism (OR, 5.22; 95% CI, 1.43-19.01), and noninvasive disease (OR, 4.53; 95% CI, 1.54-13.34) were associated with penicillin resistance, whereas intravenous drug use (OR, 0.14; 95% CI, 0.03-0.74) was not. Statistical analyses of the variables associated with resistance to multiple antibiotics detected age of younger than 5 years (OR, 16.79; 95% CI, 1.60-176.34) or of 65 years or older (OR, 4.33; 95% CI, 1.42-13.21) and previous use of b-lactam antibiotics by patients with noninvasive disease (OR, 7.92; 95% CI, 1.84-34.06) as parameters associated with increased risk. We conclude that multivariate analysis provides clues for empirical therapy for pneumococcal infection. The overall clinical spectrum of pneumococcal infection in-For many years, pneumococci were uniformly susceptible cludes other entities aside from invasive disease [4, 5]. In a to penicillin. However, since the first isolate resistant to penicilprospective study of pneumococcal disease, both invasive and lin was reported from Australia in 1967 [1], the problem of noninvasive, in Cádiz, Spain, we determined the risk factors penicillin resistance has spread throughout the world [2]. The associated with resistance to penicillin and other antibiotics. frequency and severity of pneumococcal infections, together Our findings facilitate the choice of initial empirical antibiotic with the increasingly rapid discovery of pneumococcal strains therapy for pneumococcal infection. resistant to antimicrobial agents, underscore the need for developing more effective therapeutic, preventive, and control measures. Although infections due to penicillin-resistant pneumococci Materials and Methods may occur more often in patients with identifiable predisposing We performed a population-based study in Cádiz (southern conditions, we are aware of only one previous prospective Spain) with the cooperation of the staffs of the infectious disstudy that analyzed the independent effect of risk factors for eases and microbiology units at five hospitals; these personnel patients with pneumococcal disease. In a population-based make up the Group for the Study of Infectious Diseases in analysis of the predictive factors for meningitis, pneumonia, Cádiz. The five hospitals (two university hospitals, one general or sepsis, Nava et al. [3] considered age of 0-4 years, presence hospital, and two acute care hospitals with specialized departof immunosuppressive underlying disease, and previous use of ments) serve a population of 1,100,000 people. From February b-lactam antibiotics as factors for invasive infection by resis-1993 to March 1994, all isolates of Streptococcus pneumoniae tant pneumococci. from hospitalized patients were subjected to uniform microbiological analysis and clinical study. Only those isolates of clinical significance were evaluated. Clinical study. All patients from whom S. pneumoniae was
Zentralblatt für Bakteriologie, 1998
This study was aimed to define the carriage rates for Streptococcus pneumoniae in a given population in Ankara and also to determine the serotypes and penicillin resistance of these strains. Oropharyngeal swabs were taken from a total of 661 children aged between 0-11 years and living in a province of Ankara between January 1995-January 1997. Serotyping was performed by detection of the Quellung reaction. The isolates were screened for penicillin susceptibility by the agar dilution method according to the guidelines of NceLS. The total rate of pneumococcal carriage in the study population was 23.90% and the isolation rate was found to be statistically associated with age, being higher in small children. Among the 158 S. pneumoniae isolates, the most prevalent serotypes (in order of frequency) were 6, 19,9,23,3 and 14. Penicillin susceptibility was examined in 120 of the isolates. 55 of them (45.83 %) were susceptible, 53 (44.17%) were intermediately and 12 (10.0%) were highly resistant to penicillin. Evaluation of the results showed that serotypes 6, 14 and 23 were those most often associated with penicillin resistance. The significant rate of isolation of penicillin-resistant pneumococci in healthy carriers points to the importance of active immunization in risk groups and also the importance of the rational use of antibiotics to limit the spread of resistant strains.
BMC Research Notes, 2014
Background: Streptococcus pneumoniae is the leading cause of community-acquired pneumonia in Africa. Antimicrobial resistance of S. pneumoniae to penicillin and other commonly used antibiotics has increased worldwide. However, prevalence data from the African region are sparse, especially with regard to adults. Findings: In this study, adult patients presenting at an urban referral hospital in central Mozambique were screened for pneumococcal pneumonia during an 8-week period in 2010: Patients with a respiratory syndrome underwent chest radiography and a sputum sample was collected for pneumococcal culture and antimicrobial susceptibility testing. A urine sample was tested for the presence of pneumococcal antigen. 177 patients with a respiratory syndrome were included. Overall, 41/177 (23%) patients fulfilled criteria for definite or probable pneumococcal pneumonia and in the group of patients with a positive chest x-ray this concerned 35/86 (41%) patients. 166 sputum cultures yielded 16 pneumococcal strains. One mg oxacillin disc testing identified potential penicillin resistance in 7/16 (44%) strains. Penicillin minimal inhibitory concentrations (MICs) were measured for 15 of these strains and ranged from <0.016-0.75 mg/L. No MICs >2 mg/L were found, but 3/15 (20%) pneumococcal strains had MICs >0.5 mg/L. All pneumococci were sensitive to erythromycin as measured by disc diffusion testing, whereas 44% was resistant to trimethoprim-sulfametoxazole. Conclusions: The proportion of pneumonia cases attributable to pneumococcus appeared to be high. Whilst none of the S. pneumoniae strains tested were penicillin resistant, standard penicillin dosing for pneumonia may be insufficient given the observed range of pneumococcal penicillin MICs.
Antibiotic-resistant pneumococci in hospitalized children
The Journal of hygiene, 1984
A search for nasopharyngeal carriers of Streptococcus pneumoniae was conducted in 573 children hospitalized in Durban, South Africa. Study subjects were divided into two groups, comprising 305 new admissions and 268 patients who had been hospitalized for more than 24 h. Of the 573 children 178 (31%) yielded pneumococci on nasopharyngeal culture; 99 (32%) and 79 (29%) children in the new admission and in-patient categories respectively. Twenty-one (12%) pneumococci were resistant to penicillin, including 11 strains that were resistant to more than one antibiotic. Resistant pneumococci belonged exclusively to serotypes 6 and 19 (Danish nomenclature), which were also the commonest serotypes among penicillin-sensitive strains. Factors that correlated with carriage of penicillin-resistant pneumococci were hospitalization for more than 24 h, young age and recent exposure to beta-lactam antibiotics.