Clinical Outcomes of Pneumococcal Pneumonia Caused by Antibiotic-Resistant Strains in Asian Countries: A Study by the Asian Network for Surveillance of Resistant Pathogens

Abstract

To evaluate the clinical outcomes of pneumococcal pneumonia caused by antibiotic-resistant strains in Asian countries, we performed a prospective observational study of 233 cases of adult pneumococcal pneumonia in 9 Asian countries from January 2000 to June 2001. Among 233 isolates, 128 (55%) were not susceptible to penicillin (25.3% were intermediately susceptible, and 29.6% were resistant). Clinical severity of pneumococcal pneumonia was not significantly different between antibiotic-resistant and antibiotic-susceptible groups. Mortality rates among patients with pneumococcal pneumonia caused by penicillin-, cephalosporin-, or macrolideresistant strains were not higher than those with antibiotic-susceptible pneumococcal pneumonia. Bacteremia and mechanical ventilation were significant risk factors for death, but any kind of antibiotic resistance was not associated with increased mortality due to pneumococcal pneumonia. Outcome of pneumococcal pneumonia was not significantly affected by drug resistance, and current antimicrobial regimens are mostly effective in the treatment of pneumococcal pneumonia, despite the widespread emergence of in vitro resistance.Streptococcus pneumoniae remains one of the most important bacterial pathogens causing communityacquired pneumonia, meningitis, otitis media, and septicemia. Since the 1980s, global emergence of in vitro

Genotypes and Related Factors Reflecting Macrolide Resistance in Pneumococcal Pneumonia Infections in Japan

“…In our study, 11 double ermB-and mefA-positive isolates also had low-level telithromycin susceptibility (MIC ϭ 0.06 to 1 mg/liter; MIC 90 ϭ 0.5 mg/liter) and greater resistance than solely ermB-positive isolates or solely mefA- Reported risk factors for macrolide-resistant S. pneumoniae, such as the previous use of antibiotics and hospital admission, were not confirmed in our study. Although Song et al reported that older age and, as a result, higher PSI scores, were independent predictors of erythromycin-resistant pneumococcal pneumonia (30), age and PSI score were not associated with the presence of macrolide resistance genes in our study. This was probably because of the high prevalence of erythromycin-resistant S. pneumoniae among CAP patients with each genotype.…”

“…Recent studies have defined risk factors for macrolide resistance in pneumococcal pneumonia and invasive infections. These included previous hospital admission, penicillin resistance, advanced age, a higher pneumonia severity index (PSI) score, human immunodeficiency virus infection, and previous penicillin or macrolide use (1,30,35). Risk factors for antimicrobial resistance are useful for avoiding inappropriate therapy.…”

Análise das cepas de Streptococcus pneumoniae causadores de pneumonia invasiva: sorotipos e sensibilidade aos antimicrobianos

“…[14][15][16][17][18] The main reasons for abandoning penicillin in the treatment of pneumococcal pneumonia are the progressive increase of penicillin resistance in S. pneumoniae and the absence of a consensus on optimal dosage. 23 Pharmacokinetics and pharmacodynamics data suggest that, in the treatment of pneumonia, beta-lactam antibiotics are effective against pneumococci with MICs of up to 4 µg/mL.…”

“…[12][13][14] Later multicenter studies confirmed these results. 15,16 On the basis of these findings and of a review and S. pneumoniae strains were isolated from blood cultures using the BacT/ALERT ® detection system (Biomérieux, France), whereas pleural fluid specimens were cultured on chocolate agar and sheep blood agar (Biomérieux, Rio de Janeiro, Brazil). Pure cultures were taken from blood agar.…”

Community-acquired Pneumonia in North American Emergency Departments: Drug Resistance and Treatment Success with Clarithromycin

“…Other studies of SP-positive patients with CAP have demonstrated similar findings, even with sicker patients and variable antibiotic administration. 18 Moreover, because most patients recover, it is arguable that the initial therapeutic decision is less important than ensuring reliable follow-up to identify the small percentage of patients who do not fair well. Finally, from our analyses, no factors are readily apparent to assist clinicians in estimating who might experience a relapse after discharge, at least in those patients with class I-III CAP.…”