Journal Article

Drug-Resistant Pneumococcal Pneumonia: Clinical Relevance and Related Factors

Javier Aspa, Olga Rajas, Felipe Rodríguez de Castro, José Blanquer, Rafael Zalacain, Asunción Fenoll, Rosa de Celis, Antonio Vargas, Francisco Rodríguez Salvanés, Pedro Pablo España, Jordi Rello and Antoni Torres

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 38, issue 6, pages 787-798
Published in print March 2004 | ISSN: 1058-4838
Published online March 2004 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/381886
Drug-Resistant Pneumococcal Pneumonia: Clinical Relevance and Related Factors

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A multicenter study of 638 cases of community-acquired pneumonia due to Streptococcus pneumoniae (SP-CAP) was performed to assess current levels of resistance. Of the pneumococcal strains, 35.7% had an minimum inhibitory concentration (MIC) of penicillin of ⩾0.12 µg/mL (3 isolates had an MIC of 4 µg/mL), 23.8% had an MIC of erythromycin of 128 µg/mL, and 22.2% were multidrug resistant. Logistic regression determined that chronic pulmonary disease (odds ratio [OR], 1.44], human immunodeficiency virus infection (OR, 1.98), clinically suspected aspiration (OR, 2.12), and previous hospital admission (OR, 1.69) were related to decreased susceptibility to penicillin, and previous admission (OR, 1.89) and an MIC of penicillin of MIC ⩾0.12 µg/mL (OR, 15.85) were related to erythromycin resistance (MIC, ⩾1 µg/mL). The overall mortality rate was 14.4%. Disseminated intravascular coagulation, empyema, and bacteremia were significantly more frequent among patients with penicillin-susceptible SP-CAP. Among isolates with MICs of penicillin of ⩾0.12 µg/mL, serotype 19 was predominant and was associated with a higher mortality rate. In summary, the rate of resistance to β-lactams and macrolides among S. pneumoniae that cause CAP remains high, but such resistance does not result in increased morbidity.

Journal Article.  5599 words.  Illustrated.

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

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