Journal Article

An International Prospective Study of Pneumococcal Bacteremia: Correlation with In Vitro Resistance, Antibiotics Administered, and Clinical Outcome

Chiou, Christine C. C., Luna, Carlos M., Ortqvist, Ake, Andremont, Antoine, Morris, Arthur J., Rello, Jordi, Snydman, David R., Baddour, Larry M., Chedid, M. Bernadete F., Yu, Victor L., Feldman, Charles, Ip, Margaret, Ko, Wen Chien, Klugman, Keith P.

2003

Overview

We performed a prospective, international, observational study of 844 hospitalized patients with blood cultures positive for Streptococcus pneumoniae. Fifteen percent of isolates had in vitro intermediate susceptibility to penicillin (minimum inhibitory concentration [MIC], 0.12–1 μg/mL), and 9.6% of isolates were resistant (MIC, ⩾2 μg/mL). Age, severity of illness, and underlying disease with immunosuppression were significantly associated with mortality; penicillin resistance was not a risk factor for mortality. The impact of concordant antibiotic therapy (i.e., receipt of a single antibiotic with in vitro activity against S. pneumoniae) versus discordant therapy (inactive in vitro) on mortality was assessed at 14 days. Discordant therapy with penicillins, cefotaxime, and ceftriaxone (but not cefuroxime) did not result in a higher mortality rate. Similarly, time required for defervescence and frequency of suppurative complications were not associated with concordance of β-lactam antibiotic therapy. β-Lactam antibiotics should still be useful for treatment of pneumococcal infections that do not involve cerebrospinal fluid, regardless of in vitro susceptibility, as determined by current NCCLS breakpoints.

• Publisher: The University of Chicago Press,University of Chicago Press
• Subject: Adolescent / Adult / Aged / Aged, 80 and over / Anti-Bacterial Agents - pharmacology / Anti-Bacterial Agents - therapeutic use / Antibiotics / Bacteremia / Bacteremia - drug therapy / Bacteremia - microbiology / Bacteremia - mortality / Bacterial diseases / Bacterial sepsis / Biological and medical sciences / Blood / Chronic diseases / Disease risk / Drug Resistance, Bacterial / Human bacterial diseases / Humans / Infectious diseases / Major Articles / Medical sciences / Microbial Sensitivity Tests / Middle Aged / Mortality / Penicillin / Penicillin Resistance - physiology / Penicillins - pharmacology / Penicillins - therapeutic use / Pneumococcal Infections - drug therapy / Pneumococcal Infections - microbiology / Pneumococcal Infections - mortality / Pneumococcal pneumonia / Predisposing factors / Prospective Studies / Risk Factors / Staphylococcal infections, streptococcal infections, pneumococcal infections / Statistics as Topic / Streptococcus pneumoniae / Streptococcus pneumoniae - drug effects / Treatment Outcome