JAC Advance Access originally published online on June 23, 2004
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Journal of Antimicrobial Chemotherapy 2004 54(2):481-488; doi:10.1093/jac/dkh338
JAC vol.54 no.2 © The British Society for Antimicrobial Chemotherapy 2004; all rights reserved.
Influence of penicillin resistance on outcome in adult patients with invasive pneumococcal pneumonia: is penicillin useful against intermediately resistant strains?
1 Infectious Disease Department and 2 Microbiology Department, Hospitals Vall d'Hebron, Universitat Autònoma de Barcelona, P° Vall d'Hebron 119–129, 08035 Barcelona, Spain
* Corresponding author. Tel: +34-93-274-60-90; Fax: +34-93-428-27-62; Email: vfalco{at}vhebron.net
Objectives: To compare outcome between patients with pneumonia due to penicillin-susceptible S. pneumoniae and patients with pneumonia due to penicillin intermediately resistant strains and to study the outcome of patients with pneumococcal pneumonia caused by strains with MICs of 0.12–1 mg/L treated empirically during the first 48 h with ß-lactam antibiotics.
Materials and methods: We studied 247 adult patients with invasive pneumococcal pneumonia occurring from 1997 to 2001. The following data were recorded from each patient: socio-demographic characteristics, underlying diseases, clinical presentation, initial severity of pneumonia, initial and subsequent antimicrobial therapy, in-hospital complications, hospital mortality and length of hospital stay. Multivariate analysis was done to identify variables associated with the development of pneumonia caused by a non-susceptible strain.
Results: The overall presence of penicillin non-susceptibility was 26.7%; no strain had an MIC >2 mg/L. Overall mortality was 23.5% in patients with pneumonia caused by intermediately resistant pneumococci and 12.7% in those with pneumonia caused by susceptible strains (P=0.075). Mortality during the first 7 days of admission, considered to be pneumonia-related deaths (13.7% versus 9.9%; P=0.448) was similar in both groups. The multivariate analysis showed that serotype 14 (OR, 140.18; 95% CI, 16.95–1159.20), serotype 19 (OR, 7.53; 95% CI, 1.98–28.7), haematological malignancy or splenectomy (OR, 4.46; 95% CI, 1.5–13.23) and HIV infection (OR, 4.54; 95% CI, 1.54–13.44) were the only independent factors associated with pneumonia caused by penicillin intermediately resistant pneumococci. In patients with strains having MICs of 0.1–1 mg/L, overall mortality was similar in the group of penicillin-treated patients (22.2%) to those treated with broad-spectrum ß-lactams (23.5%).
Conclusions: There is a non-significant trend to higher mortality in patients with pneumococcal pneumonia caused by intermediately resistant strains; however, they do not have a poorer outcome when they are treated with amoxicillin.
Keywords: ß-lactams , penicillin non-susceptible pneumococci , Streptococcus pneumoniae
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