Cefuroxime for Empiric Treatment of Community-Acquired Pneumococcal Pneumonia: Is There a Generation Gap?

Abstract

Background:Streptococcus pneumoniae infection is an important cause of morbidity and mortality. The recommendations to use expanded-spectrum β-lactam drugs for patients with community-acquired pneumonia derived from the growing prevalence of penicillin-resistant pneumococci. Controversy exists regarding the use of second generation cephalosporins for empirical treatment of community-acquired pneumonia. Methods: In a retrospective study, 31 adult patients with pneumococcal pneumonia and bacteremia caused by S. pneumoniae that was intermediately resistant to penicillin were compared with 31 control patients with similar infection caused by penicillin-susceptible pneumococci. All patients were treated empirically with cefuroxime, alone or in combination with other antibiotics. Morbidity and mortality were studied. Results: All unsusceptible pneumococci isolates were intermediately resistant to penicillin. No cases of fully resistant pneumococci were isolated from blood cultures in our hospital. Two factors were significantly associated with non-susceptibility to penicillin: hematologic malignancy and immunosuppression. No significant difference in morbidity or mortality was detected between the 2 groups, and penicillin minimum inhibitory concentration was not found to be a factor associated with mortality. Conclusions: Patients with pneumococcal pneumonia caused by intermediately resistant pneumococci can be empirically treated with cefuroxime. In regions where fully resistant pneumococci are rare, the use of a second generation cephalosporin for empiric treatment of community-acquired pneumonia may be appropriate.

Pneumococcal lineages associated with serotype replacement and antibiotic resistance in childhood invasive pneumococcal disease in the post-PCV13 era: an international whole-genome sequencing study

“…For example, although GPSC26 persisted in Israel without significant changes in incidence between pre-PCV and PCV13 periods, GPSC55, with 100% resistance to penicillin, significantly increased in Israel in that time, which might be due to the common use of β-lactam antibiotics for treating pneumococcal disease in the country. 33 By contrast, GPSC26, with cotrimoxazole resistance but susceptibility to penicillin, was the predominant lineage, accounting for most of the serotype 12F isolates, in The Gambia and South Africa, where cotrimoxazole is widely used to prevent bacterial infection in people with HIV. 34,35 In South Africa, we observed that a serotype 15B/C lineage (GPSC25) replaced another serotype 15B/C lineage (GPSC48) during the introduction of PCVs; an event known as clonal replacement.…”