Antimicrobial susceptibility of Streptococcus pneumoniae in adult patients with pneumococcal pneumonia in an urban hospital in Mozambique (original) (raw)
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Penicillin-resistant pneumococcus and risk of treatment failure in pneumonia
Archives of Disease in Childhood, 2008
Objective: To determine whether the presence of in vitro penicillin-resistant Streptococcus pneumoniae increases the risk of clinical failure in children hospitalised with severe pneumonia and treated with penicillin/ampicillin. Design: Multicentre, prospective, observational study. Setting: 12 tertiary-care centres in three countries in Latin America. Patients: 240 children aged 3-59 months, hospitalised with severe pneumonia and known in vitro susceptibility of S pneumoniae. Intervention: Patients were treated with intravenous penicillin/ampicillin after collection of blood and, when possible, pleural fluid for culture. The minimal inhibitory concentration (MIC) test was used to determine penicillin susceptibility of the pneumococcal strains isolated. Children were continuously monitored until discharge. Main outcome measures: The primary outcome was treatment failure (using clinical criteria). Results: Overall treatment failure was 21%. After allowing for different potential confounders, there was no evidence of association between treatment failure and in vitro resistance of S pneumoniae to penicillin according to the Clinical Laboratory Standards Institute (CLSI)/National Committee for Clinical Laboratory Standards (NCCLS) interpretative standards ( adj RR = 1.03; 95%CI: 0.49-1.90 for resistant S pneumoniae). Conclusions: Intravenous penicillin/ampicillin remains the drug of choice for treating penicillin-resistant pneumococcal pneumonia in areas where the MIC does not exceed 2 mg/ml.
Research Square (Research Square), 2020
Backgrounds: Streptococcus pneumoniae is one of the leading causes of bacterial meningitis and pneumoniae in elderly people and children. Antimicrobial resistant strains of Streptococcus pneumoniae has been detected in all parts of the world and become one of the greatest challenges to global public health today. The aim of this study is therefore, to assess the antimicrobial resistance pro les and multidrug resistance patterns of S. pneumoniae isolates from patients suspected for pneumococcal infections in Ethiopia. Methods: A hospital-based prospective study was conducted from 2018 to 2019 at Addis Ababa and Amhara region referral hospitals. Antimicrobial resistance tests were performed on 57 isolates of S. pneumoniae that were collected from pediatric and adult patients. Samples (cerebrospinal uid, blood, sputum, eye discharge, ear discharge, pleural and peritoneal uids) from all collection sites were initially cultured onto 5 % sheep blood agar plates and incubated overnight at 37 0 C in 5% CO 2 atmosphere. S. pneumoniae was identi ed and con rmed by typical colony morphology, alpha-hemolysis, Gram staining, optochin susceptibility and bile solubility test. Drug resistance testing was performed using E-test method according to recommendations of the Clinical and Laboratory Standards Institute. Results: Of the 57 isolates, 17.5% were fully resistant to penicillin. Corresponding value for both cefotaxime and ceftriaxone was 1.8%. Resistance rates to erythromycin, clindamycin, tetracycline, chloramphenicol and trimethoprim-sulfamethoxazole were 59.6%, 17.5%, 38.6%, 17.5% and 24.6%, respectively. Multidrug resistance (MDR) was seen in 33.3% isolates. The most common pattern was coresistance to penicillin, erythromycin, clindamycin and tetracycline. Conclusions: Most bacterial isolates were susceptible to Ceftriaxone and Cefotaxime. Penicillin has been used as a drug of choice for treating S. pneumoniae infection. However, antimicrobial resistance including multidrug resistance was observed to a number of commonly used antibiotics including penicillin. Hence, it is important to periodically monitor the antibiotic resistance patterns to choose empirical treatments for better management of pneumococcal infection.
Study of Invasive Pneumococcal Infection in Adults with Reference to Penicillin Resistance
Journal of Laboratory Physicians, 2017
Background: Invasive pneumococcal infections often prove rapidly fatal, even where good medical treatment is readily available. In developed countries, up to 20% of people who contract pneumococcal meningitis die; however, in developing world, mortality is closer to 50%, even among hospitalized patients. The World Health Organization estimated 600,000–800,000 adult deaths each year from pneumococcal pneumonia, meningitis, and sepsis. Aims: This study aims to estimate isolation rate of invasive pneumococcal infection in adults, to determine the antimicrobial susceptibility profile of Streptococcus pneumoniae isolates and to study the associated risk factors. Materials and Methods: A total of 120 patients with suspected invasive infection such as meningitis, septicemia, and pleural effusion, were included in the study. Various clinical specimens such as pus, cerebrospinal fluid, and other sterile body fluids were processed for isolation and identification of S. pneumoniae. Kirby–Bauer...
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
Annals of Clinical Microbiology and Antimicrobials, 2021
Background: Antimicrobial-resistant strains of Streptococcus pneumoniae have become one of the greatest challenges to global public health today and inappropriate use of antibiotics and high level of antibiotic use is probably the main factor driving the emergence of resistance worldwide. The aim of this study is, therefore, to assess the antimicrobial resistance profiles and multidrug resistance patterns of S. pneumoniae isolates from patients suspected of pneumococcal infections in Ethiopia. Methods: A hospital-based prospective study was conducted from January 2018 to December 2019 at Addis Ababa city and Amhara National Region State Referral Hospitals. Antimicrobial resistance tests were performed from isolates of S. pneumoniae that were collected from pediatric and adult patients. Samples (cerebrospinal fluid, blood, sputum, eye discharge, ear discharge, and pleural and peritoneal fluids) from all collection sites were initially cultured on 5% sheep blood agar plates and incubated overnight at 37 °C in a 5% CO 2 atmosphere. Streptococcus pneumoniae was identified and confirmed by typical colony morphology, alpha-hemolysis, Gram staining, optochin susceptibility, and bile solubility test. Drug resistance testing was performed using the E-test method according to recommendations of the Clinical and Laboratory Standards Institute. Results: Of the 57 isolates, 17.5% were fully resistant to penicillin. The corresponding value for both cefotaxime and ceftriaxone was 1.8%. Resistance rates to erythromycin, clindamycin, tetracycline, chloramphenicol and trimethoprimsulfamethoxazole were 59.6%, 17.5%, 38.6%, 17.5 and 24.6%, respectively. Multidrug resistance (MDR) was seen in 33.3% isolates. The most common pattern was co-resistance to penicillin, erythromycin, clindamycin, and tetracycline. Conclusions: Most S. pneumoniae isolates were susceptible to ceftriaxone and cefotaxime. Penicillin has been used as a drug of choice for treating S. pneumoniae infection. However, antimicrobial resistance including multidrug resistance was observed to several commonly used antibiotics including penicillin. Hence, it is important to periodically
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
S treptococcus pneumoniae remains a leading cause of morbidity and mortality worldwide, both in children and adults. Clinical manifestations of disease associated with this pathogen vary, and include meningitis, bacteremia, pneumonia and otitis media (1-6). Penicillin has been the drug of choice for treatment of pneumococcal infections, but penicillinnonsusceptible (NS; intermediate + resistant) isolates of S pneumoniae (PNSP) have been reported with increasing frequency from many parts of the world (7). Of even more concern is that PNSP are more likely than penicillin-susceptible strains to be NS to other classes of antimicrobials (7). The prevalence of resistance varies from country to country, and also within countries. PNSP rates are reportedly 28% in Europe and Latin America, 31% in Malaysia and 34% in the United States (8,9). Regional variation in pneumococcal antimicrobial susceptibility has been shown to occur in the United States, Europe and Canada (10-14). Data from Canadian sources over the past 30 years show that resistance of S pneumoniae to penicillin and other antimicrobials is increasing in this country. In the late 1970s, 2.4% of S pneumoniae isolates in Alberta and the Northwest Territories were penicillin NS (15). More than 25 years later, penicillin NS rates across Canada are 11.7% to 15%, with 3.3% to 6.5% of pneumococcal isolates being penicillin resistant (14,16,17). Surveillance data of S pneumoniae isolates submitted to participating laboratories in 2002 revealed penicillin originAl Article
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.
Antimicrobial Agents and Chemotherapy, 1983
From August 1978 to December 1981, 200 Streptococcus pneumoniae strains isolated from adult patients with pneumococcal disease were tested for susceptibility to penicillin G, erythromycin, clindamycin, tetracycline, and chloramphenicol by disk diffusion. Minimal inhibitory concentrations (MICs) were determined by agar dilution and broth dilution. The sources (numbers) of these isolates were blood (111), cerebrospinal fluid (30), sputum (26), pleural fluid (16), and miscellaneous (17). Of the 200 strains, 18 were partially resistant (MIC, 0.1 to 1 micrograms/ml) and 2 were resistant to penicillin. A total of 144 (72%) strains were tetracycline resistant, 87 of which had MICs of greater than or equal to 64 micrograms/ml. Ninety (45%) isolates exhibited various degrees of chloramphenicol resistance, with MICs ranging from 16 to 64 micrograms/ml. Five strains were resistant to erythromycin and clindamycin. Eleven penicillin-resistant strains were also resistant to chloramphenicol and te...