Factors Associated With Antimicrobial Resistance and Mortality in Pneumococcal Bacteremia

Abstract

We conducted a multicenter, retrospective cohort study of patients with Streptococcus pneumoniae bacteremia to determine factors associated with antibiotic resistance and mortality. Risk factors were identified using multivariate logistic regression. 1,574 patients at 34 sites were enrolled. Compared to isolates from patients not receiving an antibiotic before the index blood culture, patients receiving an antibiotic were less likely to harbor an antibiotic susceptible organism. Susceptibility to penicillin decreased from 78% (95% confidence interval [CI], 75−80) to 49% (95%CI, 39−59); to cefotaxime/ ceftriaxone, from 92% (95%CI, 90−93) to 82% (95%CI, 72−89); and to macrolide, from 84% (95% CI, 82−87) to 55% (95%CI, 41−68). Factors associated with macrolide non-susceptibility include: >24 hours of antibiotic therapy at time of the index culture (odds ratio [OR] 4.0), residing in southern U.S. (OR 1.7), and having an antibiotic allergy (OR 1.7). Harboring an antibiotic non-susceptible strain (OR 1.4) and male sex (OR 1.4) were associated with increased risk of mortality, whereas Black race (OR 0.6) and evidence of focal infection (OR 0.6) were associated with decreased risk.

Initial management of and outcome in patients with pneumococcal bacteremia: a retrospective study at a Swiss university hospital, 2003–2009

“…Last, the range of conditions varied between the infection of cryptic origin to meningitis, and the impact of delayed antibiotic administration in some of these conditions may be less significant than others. On the other hand, the existing literature suggests that pneumococcal bacteremia, per se, is a strong indicator of a serious clinical condition, irrespective of the origin, and, thus, the variations in clinical conditions may be of less importance [22].…”

Drug-resistance in Streptococcus pneumoniae isolates among Spanish middle aged and older adults with community-acquired pneumonia

“…If we consider penicillin-resistant pneumococci, data reported on mortality has not been uniform[4,8,9]. …”

Application of the Formula for Rational Antimicrobial Therapy (FRAT) to Community-Acquired Pneumonia

“…Findings from recent surveillance studies [54,55,65] support the observations from PROTEKT and SENTRY surveillance studies; S. pneumoniae and Mycoplasma resistance to antimicrobial agents overall is changing and differs by region. Macrolide resistance rates are higher in the Southeast, North Central and South Central Regions, and a retrospective cohort study identified residing in the southern United States as a risk factor for macrolide-nonsusceptible pneumococci [66]. The identification of a positive relationship between macrolideresistant S. pneumoniae and macrolide treatment failure in patients with CABP [24] demonstrates the current impact of resistance and continued prescribing of ineffective treatments.…”