Journal Article

Effect of Penicillin Resistance of <i>Streptococcus pneumoniae</i> on the Presentation, Prognosis, and Treatment of Pneumococcal Endocarditis in Adults

Esteban Martínez, Jose M. Miró, Benito Almirante, Jose M. Aguado, Pedro Fernandez-Viladrich, Manuel L. Fernandez Guerrero, Jose L. Villanueva, Fernando Dronda, Alfonso Moreno-Torrico, Miguel Montejo, Pedro Llinares and Jose M. Gatell

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 35, issue 2, pages 130-139
Published in print July 2002 | ISSN: 1058-4838
Published online July 2002 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/341024
Effect of Penicillin Resistance of Streptococcus pneumoniae on the Presentation, Prognosis, and Treatment of Pneumococcal Endocarditis in Adults

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We performed a clinical study of pneumococcal endocarditis (PE) in adults at 15 major Spanish hospitals during a 21-year period (1978–1998). During this time, 63 patients had PE due to Streptococcus pneumoniae diagnosed. Of the 63 isolates recovered from these patients, 24 (38%) and 6 (10%) showed resistance to penicillin (minimum inhibitory concentration [MIC], 0.1–4 µg/mL) and cefotaxime (MIC, 1 µg/mL), respectively. Twenty-two (35%) of the patients died. Left-side heart failure, but not penicillin resistance, was independently associated with a higher risk of death (odds ratio, 1.33; 95% confidence interval, 1.04–1.71; P = .026). Patients without meningitis who had PE due to penicillin-resistant S. pneumoniae could be treated with high-dose penicillin or a third-generation cephalosporin if the MIC for penicillin was ≤1 µg/mL. For patients with concurrent meningitis, high doses of cefotaxime could be used if the MIC for cefotaxime was ≤1 µg/mL. Early recognition of heart failure and surgery may help to decrease mortality.

Journal Article.  4822 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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