Drug‐Resistant Pneumococcal Pneumonia: Clinical Relevance and Related Factors

Abstract

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 > or =0.12 microg/mL (3 isolates had an MIC of 4 microg/mL), 23.8% had an MIC of erythromycin of 128 microg/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 > or =0.12 microg/mL (OR, 15.85) were related to erythromycin resistance (MIC, > or =1 microg/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 > or =0.12 microg/mL, serotype 19 was predominant and was associated with a higher mortality rate. In summary, the rate of resistance to beta -lactams and macrolides among S. pneumoniae that cause CAP remains high, but such resistance does not result in increased morbidity.

Colonization of Streptococcus pneumoniae in Pneumonia Patients with Lung Cancer

“…Although none of our isolates was resistant to penicillin, 12.8% and 20% of our isolates respectively from blood culture and BAL specimens were found to be resistant to amoxicillin. We report that 48.7% and 60% of our isolates respectively from blood culture and BAL specimens were found to be resistant to erythromycin, which were higher than that reported (28%) elsewhere (40)(41)(42). The MIC 50 and MIC 90 of erythromycin against S. pneumoniae isolated from both blood culture and BAL specimens were 1 µg/mL and 64 µg/mL (range: ≤ 0.03 to > 128 µg/mL), respectively.…”

“…Erythromycin-resistant S. pneumoniae complicates the choice of antibiotic treatment since other macrolides such as clarithromycin and azithromycin might not be ideal choices where the prevalence of resistant pneumococci is high (38)(39)(40)(41)(42). We report an overall mortality of 9.9%, which is lower than that reported (30%) from France (43) reported that the local prevalence and bacterial resistance patterns determine the choice of first-line empiric therapy (44).…”

Impact of initial antibiotic choice on mortality from pneumococcal pneumonia

“…Patients and study design From January, 1999 to April, 2000, 638 consecutive adults with CAP-SP were enrolled in 35 Spanish hospitals [17]. A 30-day mortality, from the time of diagnosis, was considered the endpoint of the analysis [18].…”

“…In Spain, almost 40% of pneumococci strains express diminished susceptibilty to penicillin and approximately one-third of the isolates are macrolide resistant, most of them having macrolides lincosamides streptogramin-B phenotype [17]. The current authors, therefore, considered that Spain provides a good environment in which to respond to the previously mentioned controversies.…”

“…All pneumococcal isolates were submitted to the National Center of Microbiology for serotyping [17,19,20] and susceptibility verification, according to the National Committee for Clinical Laboratory Standards 2002 [21]. The following antibiotics were tested: penicillin, amoxicillin, cefuroxime, cefotaxime, imipenem, vancomycin, teicoplanin, erythromycin, tetracycline, chloramphenicol and levofloxacin.…”