ABSTRACT
Background
Invasive Streptococcus pneumoniae pneumonia among adults due to penicillin-resistant or intermediate resistant strains
was investigated to determine whether these patients responded poorly to common antibiotic
regimens compared to pneumonia due to susceptible strains.
Methods
During a 21-year period (1983–2003), clinical outcome was analyzed among 3 groups
of adults, 19 with resistant, 33 with intermediate, and 133 with susceptible invasive
S pneumoniae pneumonia admitted to hospitals in Huntington, West Virginia. Adults with resistant
and intermediate infections were matched by age and month of admission to a group
of 133 adults with penicillin-susceptible infections. All isolates of resistant and
intermediate infections were capsular serotypes/serogroups 6, 9, 14, 19, and 23, and
isolates of susceptible infections included 24 different serotypes/serogroups. Case
fatality rates were calculated for deaths that occurred during the first 7, first
14, and first 21 days of hospitalization. Minimal inhibitory concentration (MIC) was determined by
E-test and capsular serotype by Quellung procedures.
Results
The resistant and susceptible groups did not differ in several measures of severity
of illness, including admission vital signs, duration of fever, mean total leukocyte
count, number of lobes involved, preexisting underlying diseases, and antibiotic treatment
regimens. There were no significant differences in case fatality rates between the
3 groups of pneumonia by days in hospital, age, severity of illness, and empiric antibiotic
treatment regimen with a cephalosporin and a macrolide, the most common antibiotic
regimen.
Conclusions
These findings provide evidence that combination antibiotic regimens effective in
the treatment of invasive susceptible S pneumoniae pneumonia are equally effective in the treatment of invasive resistant (MIC=2–4 μg/mL) and of intermediate (MIC=0.1–1 μg/mL) S pneumoniae pneumonia.
KEY INDEXING TERMS
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Article info
Publication history
Accepted:
November 1,
2006
Received:
July 24,
2006
Footnotes
The Department of Medicine provided funds to support of this research.
An abstract of this work exists on disk and was presented orally at the 16th ECCMID in Nice, April 3, 2006, under the title “Outcome of Adults with Penicillin High-Resistant and Susceptible Invasive Streptococcus pneumoniae Community-Acquired Pneumonia.”
Identification
Copyright
© 2007 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.
