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Influence of penicillin resistance on outcome in adult patients with invasive pneumococcal pneumonia: is penicillin useful against intermediately resistant strains?
J Antimicrob Chemother. 2004 Aug; 54(2):481-8.JA

Abstract

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 beta-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 beta-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.

Authors+Show Affiliations

Infectious Disease Department, Hospitals Vall d'Hebron, Universitat Autònoma de Barcelona, P degrees Vall d'Hebron 119-129, 08035 Barcelona, Spain. vfalco@vhebron.netNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

15215226

Citation

Falcó, Vicenç, et al. "Influence of Penicillin Resistance On Outcome in Adult Patients With Invasive Pneumococcal Pneumonia: Is Penicillin Useful Against Intermediately Resistant Strains?" The Journal of Antimicrobial Chemotherapy, vol. 54, no. 2, 2004, pp. 481-8.
Falcó V, Almirante B, Jordano Q, et al. Influence of penicillin resistance on outcome in adult patients with invasive pneumococcal pneumonia: is penicillin useful against intermediately resistant strains? J Antimicrob Chemother. 2004;54(2):481-8.
Falcó, V., Almirante, B., Jordano, Q., Calonge, L., del Valle, O., Pigrau, C., Planes, A. M., Gavaldà, J., & Pahissa, A. (2004). Influence of penicillin resistance on outcome in adult patients with invasive pneumococcal pneumonia: is penicillin useful against intermediately resistant strains? The Journal of Antimicrobial Chemotherapy, 54(2), 481-8.
Falcó V, et al. Influence of Penicillin Resistance On Outcome in Adult Patients With Invasive Pneumococcal Pneumonia: Is Penicillin Useful Against Intermediately Resistant Strains. J Antimicrob Chemother. 2004;54(2):481-8. PubMed PMID: 15215226.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Influence of penicillin resistance on outcome in adult patients with invasive pneumococcal pneumonia: is penicillin useful against intermediately resistant strains? AU - Falcó,Vicenç, AU - Almirante,Benito, AU - Jordano,Queralt, AU - Calonge,Laura, AU - del Valle,Oscar, AU - Pigrau,Carles, AU - Planes,Ana María, AU - Gavaldà,Joan, AU - Pahissa,Albert, Y1 - 2004/06/23/ PY - 2004/6/25/pubmed PY - 2004/10/16/medline PY - 2004/6/25/entrez SP - 481 EP - 8 JF - The Journal of antimicrobial chemotherapy JO - J Antimicrob Chemother VL - 54 IS - 2 N2 - 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 beta-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 beta-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. SN - 0305-7453 UR - https://www.unboundmedicine.com/medline/citation/15215226/Influence_of_penicillin_resistance_on_outcome_in_adult_patients_with_invasive_pneumococcal_pneumonia:_is_penicillin_useful_against_intermediately_resistant_strains L2 - https://academic.oup.com/jac/article-lookup/doi/10.1093/jac/dkh338 DB - PRIME DP - Unbound Medicine ER -