Clinical Outcome of Invasive Infections in Children Caused by Highly Penicillin-Resistant Streptococcus pneumoniae Compared with Infections Caused by Penicillin-Susceptible Strains

Gómez-Barreto, Demóstenes; Calderón-Jaimes, Ernesto; Rodrı́guez, Romeo S; Monteros, Luz Elena Espinosa de los

doi:10.1016/s0188-4409(00)00244-7

Cited by 18 publications

(15 citation statements)

References 30 publications

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“…Similar to most recent studies, we did not find an increase in the incidence of complicated pneumococcal pneumonia associated with PRSP. 12,16,21,22 The only difference that we found among children infected with PRSP was that they tended to be significantly younger. This may be related to virulence factors associated with PRSP, as other workers detected the same finding.…”

Section: Discussionmentioning

confidence: 67%

“…Severe malnutrition (''wasting'') was associated with both susceptibility to bacterial pneumonia and increased morbidity. 17,22,[26][27][28] In our patient population, severe malnutrition was rare, but it appears that even moderate nutritional deficits (underweight) can increase morbidity in terms of pulmonary complications. 28 Anemia was also significantly related to complicated pneumococcal pneumonia.…”

Section: Discussionmentioning

confidence: 71%

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Clinical characteristics and outcome of complicated pneumococcal pneumonia in a pediatric population

et al. 2006

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The incidence of complicated pneumonia caused by S. pneumoniae is reported to be increasing. This increase may be related to host susceptibility and/or pathogen virulence. The objective of this study was to evaluate clinical and laboratory characteristics associated with complicated pneumococcal pneumonia, and to identify risk factors associated with prolonged fever and hospitalization. The study involved reviewing the records of all children who were hospitalized in four major hospitals in Jerusalem with a confirmed diagnosis of pneumococcal pneumonia during a 12-year period (1986-1997). Demographic, clinical, laboratory, and outcome variables were compared between those with uncomplicated and complicated pneumonia. One hundred and eleven children (median age, 2.2 years) were hospitalized with pneumococcal pneumonia during the study period. Forty-four (39%) of them had complicated pneumonia, characterized by pleural effusion, empyema, pneumothorax, pneumatocele, and/or atelectasis. There was no correlation between the isolation of penicillin-resistant S. pneumonia (16% of cases) and complicated pneumonia. Factors that were significantly associated with complicated pneumonia included weight

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Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 71%

Clinical characteristics and outcome of complicated pneumococcal pneumonia in a pediatric population

et al. 2006

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“…68 Risk factors for CAP caused by penicillin-nonsusceptible S. pneumoniae include young age, recent antibiotic use, and the presence of underlying conditions. [71][72][73][74] In vitro resistance to β-lactams does not necessarily imply clinical failure in the treatment of CAP. MIC breakpoints for β-lactams were originally developed for meningitis.…”

Section: Impact Of Antibacterial Resistancementioning

confidence: 99%

Overcoming Current Obstacles in the Management of Bacterial Community-Acquired Pneumonia in Ambulatory Children

Pelton

Hammerschlag

2005

Clin Pediatr (Phila)

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This table summarizes the bacterial and atypical/intracellular pathogens against which antibacterial therapy is targeted. For a fuller account of the range of viral, bacterial, and other pathogens responsible, please consult the text and supporting references. † S. aureus is not a common cause of CAP in the United States and Europe but may be more common in other areas. ‡ Erythromycin or azithromycin may be preferable. 1 Amoxicillin should be used as first-line treatment at any age if S. pneumoniae is thought to be the likely pathogen. 4 § Perinatally acquired C. trachomatis pneumonia has been largely eliminated in developed countries through the systematic screening and treatment of pregnant women. However, it may still be an important consideration in some countries. ** H. influenzae type b infection is rare in areas with wide vaccination use. All types are more common in developing regions. † † Doxycycline may be considered in older children, depending on local regulatory conditions (e.g., in children aged >8 years in the United States). 1 (10846)Pelton 1/4/05 12:06 PM Page 4 *Patients from 6 months to 16 years of age with CAP. Microbiology (culture or PCR) was performed on pharyngeal and nasopharyngeal specimens at baseline and at days 15-19 posttherapy. Serology was performed at baseline and 4-6 weeks posttherapy. † Serologic testing for M. pneumoniae was performed using an enzyme-linked immunosorbent assay. ‡ Serologic testing for C. pneumoniae was performed using microimmunofluorescence.PCR, polymerase chain reaction.

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“…However, even in areas with a high rate of intermediately or "highly" resistant pneumococci, penicillin or amoxicillin can still reliably be used as the first-line therapy of a pneumococcal LRTI. This statement is based on the following facts: 1) In areas in which penicillin resistance has been present for many years, the minimum inhibitory concentration of antibiotic (MIC) inhibiting 90% of bacterial strains (MIC90) is still 1 mg?L -1 , and MIC of w4 mg?L -1 are extremely rare [40,55,56]; 2) With high-dose penicillin or amoxicillin, adequate concentrations at the site of infection are achieved even when treating highly resistant (MIC f4 mg?L -1 ) pneumococci [57]; 3) To date, studies of pneumonia treated with penicillins or other b-lactams, adjusted for underlying factors and severity of illness, have shown a similar and favourable outcome in patients in whom the infection was caused by penicillin-resistant strains to that in infections caused by penicillinsensitive strains [40,55,[58][59][60][61]; 4) Among pneumococci with decreased susceptibility to penicillin (MIC o0.1 mg?L -1 ), there is a significant coresistance to common alternative antimicrobial agents, such as other b-lactams, erythromycin, clindamycin, tetracycline and trimethoprim/sulfamethoxazole [40,56,62]. For macrolides, the rate of coresistance increased during the last part of the 1990s.…”

Section: What Is the Local Antimicrobial Resistance Situation?mentioning

confidence: 99%

Treatment of community-acquired lower respiratory tract infections in adults

Örtqvist¹

2002

Eur Respir J

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Community-acquired lower respiratory tract infection (LRTI) is a common cause of acute illness in adults. The spectrum of disease ranges from a mild mucosal colonisation or infection, acute bronchitis or acute exacerbation of chronic bronchitis/chronic obstructive pulmonary disease (AE-CB/COPD), to an overwhelming parenchymal infection with the patient presenting with severe community-acquired pneumonia (CAP).Although the great majority of LRTIs are self-limiting viral infections, CAP is most often a bacterial disease with a substantial mortality. Thus, antibiotic treatment is rarely indicated for acute bronchitis and is only indicated for the more severe cases of AE-CB/COPD, but it is nearly always indicated for CAP, for which a delay in treatment may increase the risk of a fatal outcome. It may be difficult to differentiate between a viral and a bacterial LRTI, or between bronchitis/AE-CB/COPD and CAP. This may be one reason why antibiotics are prescribed to more than two-thirds of patients with LRTIs in Europe and the USA. Considering the worldwide development of antibiotic resistance, this is not an acceptable situation.Since an empirical approach is nearly always necessary in the management of LRTI, greater emphasis must be placed on the decision of whether or not to prescribe an antibiotic at all. This decision should be based on an assessment of the severity of the disease, including underlying risk factors, and on markers for bacterial/parenchymal/invasive LRTI. The choice of empirical therapy must be based on the same data together with epidemiological information. The choice of antibiotic must always coverStreptococcus pneumoniae, which remains the main pathogen of morbidity and mortality in CAP. In hospital, attempts should be made to obtain an aetiological diagnosis in order to be able to switch to a specific treatment or to evaluate a failure of empirical therapy.Several guidelines for the management of community-acquired pneumonia have been published during the last 10 yrs. Some reports indicate that the implementation of such guidelines has resulted in lowered costs, length of stay in hospital and mortality. However, the results from these studies are not consistent and the evidence is still weak.

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Clinical Outcome of Invasive Infections in Children Caused by Highly Penicillin-Resistant Streptococcus pneumoniae Compared with Infections Caused by Penicillin-Susceptible Strains

Cited by 18 publications

References 30 publications

Clinical characteristics and outcome of complicated pneumococcal pneumonia in a pediatric population

Clinical characteristics and outcome of complicated pneumococcal pneumonia in a pediatric population

Overcoming Current Obstacles in the Management of Bacterial Community-Acquired Pneumonia in Ambulatory Children

Treatment of community-acquired lower respiratory tract infections in adults

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