title: [Endocarditis due to penicillin-sensitive and -resistant pneumococci: the current perspectives on the disease].
abstract: BACKGROUND
  To evaluate the clinic characteristics and therapeutic aspects of endocarditis by Streptococcus pneumoniae sensitive and resistant to penicillin.
  
  
  METHODS
  Twelve cases of pneumococcal endocarditis evaluated in 4 Spanish hospitals over the last 10 years were studied, analyzing their clinical characteristics and the existence of resistance to penicillin. The features were compared with a series of 98 cases found in a review of the literature.
  
  
  RESULTS
  All the patients were males, most being alcoholics. The course of the disease was acute (2 weeks) in all the cases and evolved with great aggressivity: cardiac failure (9 patients), myocardial abscess (7 patients), multiple arterial embolisms (5 patients), septic arthritis (4 patients). Three patients had simultaneous pneumococcal meningitis but only one had pneumonia. The valve most affected was the aortic (9 cases). Three cases were due to strains of Streptococcus pneumoniae with moderate resistance to penicillin (CMI 0.5-1 micrograms/ml). Global mortality was 42%. All the patients receiving inadequate antibiotic treatment died. Vancomycin and cefotaxime appear to be effective in the treatment of cases produced by strains of pneumococcus with intermediate sensitivity to penicillin. There were no apparent differences in mortality between the cases of endocarditis by pneumococcus sensitive or moderately resistant to penicillin.
  
  
  CONCLUSIONS
  Pneumococcal endocarditis continues to condition a high mortality similar to that produced in previously made series. The classic relation with meningitis and pneumonia is infrequent today. The appearance of strains resistant to penicillin may increase the incidence of this infection and further worsen prognosis.
authors.affiliation: Unidad de Enfermedades Infecciosas, Servicio de Microbiologia, Hospital 12 de Octubre, Madrid.
authors.forename: J M
authors.initials: JM
authors.lastname: Aguado
authors.forename: A
authors.initials: A
authors.lastname: Casillas
authors.forename: M
authors.initials: M
authors.lastname: Lizasoaín
authors.forename: C
authors.initials: C
authors.lastname: Lumbreras
authors.forename: C
authors.initials: C
authors.lastname: Peña
authors.forename: R
authors.initials: R
authors.lastname: Martín-Durán
authors.forename: P
authors.initials: P
authors.lastname: Fernández-Viladrich
authors.forename: M L
authors.initials: ML
authors.lastname: Fernández-Guerrero
authors.forename: A R
authors.initials: AR
authors.lastname: Noriega
mesh_terms: D000328:Adult; D016470:Bacteremia / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy; D003131:Combined Modality Therapy; D004697:Endocarditis, Bacterial / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology* / Q000628:therapy; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010403:Penicillin Resistance; D011008:Pneumococcal Infections / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology* / Q000628:therapy; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D013296:Streptococcus pneumoniae / Q000187:drug effects* / Q000302:isolation & purification