Predictive Factors for Invasive Disease Due to Penicillin-Resistant Streptococcus pneumoniae: A Population-Based Study

Abstract

A prospective population-based study was carried out to determine predictive factors associated with penicillin-resistant pneumococcal invasive disease. A total of 374 patients (250 males and 124 females; mean age, 50.3 +/- 27 years) with invasive pneumococcal infection were admitted to one of the five hospitals in El Vallés County (an industrial area with 800,000 inhabitants in the province of Barcelona, Spain) over a period of 5 years. Of the 374 episodes, 21 (5.6%) were due to highly penicillin-resistant pneumococci and 67 (17.9%) to intermediately penicillin-resistant pneumococci. Multivariate analysis showed a statistically significant association between infection with intermediately penicillin-resistant pneumococci and an age of 0-4 years (odds ratio [OR] = 5.3; 95% confidence interval [CI] = 2.2-12.6), the presence of an immunosuppressive underlying disease (OR = 3.0; 95% CI = 1.5-6.0), and the previous use of beta-lactam antibiotics (OR = 2.1; 95% CI = 1.0-4.5). Infection with highly penicillin-resistant pneumococci was associated only with the previous use of beta-lactam antibiotics (OR = 5.9; 95% 95% CI = 2.2-15.8). Highly resistant strains were of serotypes 6, 9, 14, 15, 19, and 23, of which all but serotypes 9 and 15 are included in the newly formulated conjugated vaccine.

Non-antibiotic treatment recommendations: delivery formats and implications for parent resistance

“…Although the US, along with many other developed nations, is facing a large-scale problem with antibiotic resistant bacteria (Baquero, Baquero-Artigao, Canton, & Garcia-Rey, 2002;McCaig & Hughes, 1995;Neu, 1992;Reichler et al, 1992;Schwartz, 1999; Whitney et al, 2000;Wise et al, 1998), inappropriate prescribing of antibiotics for viral infections is common (Finkelstein et al, 2000;Gonzales, Malone, Maselli, & Sande, 2001;Gonzalez, Steiner, & Sande, 1997;Mainous, Hueston, & Clark, 1996;Mangione-Smith et al, in press;McCaig, Besser, & Hughes, 2002;Pennie, 1998). Inappropriate use of antibiotics has led to rapidly increasing risks of resistance among many strains of bacteria that commonly infect children and adults (Cristino, 1999;Deeks et al, 1999;Gomez et al, 1995;Nava et al, 1994;Watanabe et al, 2000). Resistant infections pose a risk not only to the individual but also to the community because those infections are more difficult to treat (Dagan, 2000;Friedland, 1995;Watanabe et al, 2000), more costly (Gums, 2002;Holmberg, Solomon, & Blake, 1987), and result in increased mortality (Feikin et al, 2000).…”

The Effect of a Community Intervention Trial on Parental Knowledge and Awareness of Antibiotic Resistance and Appropriate Antibiotic Use in Children

“…For example, the resistance of Streptococcus pneumoniae to penicillin and other antibiotics increased dramatically in the United States from the early 1980s to the 1990s. 5,6 Studies of risk factors for colonization [7][8][9][10] as well as invasive disease [11][12][13][14][15][16][17] caused by penicillin-resistant pneumococci have consistently found recent antibiotic use to be more prevalent among persons with penicillin-resistant pneumococci than among those with susceptible pneumococci. A reduction in antibiotic consumption is likely to reduce the selective pressure, slowing the emergence of resistant organisms.…”

Bacteriemia neumocócica en el adulto en un hospital de tercer nivel

“…Seis (4,8%) pacientes tuvieron más de un episodio de bacteriemia neumocócica. La bacteriemia recurrente por S. pneumoniae ha sido descrita con mayor frecuencia en pacientes que padecen neoplasias, sobre todo hematológicas, cirrosis hepática e infección por VIH (30)(31)(32)(33), en concordancia a la encontrada en nuestro estudio. A pesar de que S. pneumoniae es un germen de adquisición fundamentalmente comunitaria, ha sido descrito como patógeno implicado en infecciones nosocomiales (34,35).…”