title: Impact of penicillin susceptibility on medical outcomes for adult patients with bacteremic pneumococcal pneumonia.
abstract: The impact of penicillin susceptibility on medical outcomes for adult patients with bacteremic pneumococcal pneumonia was evaluated in a retrospective cohort study conducted during population-based surveillance for invasive pneumococcal disease in the greater Atlanta region during 1994. Of the 192 study patients, 44 (23%) were infected with pneumococcal strains that demonstrated some degree of penicillin nonsusceptibility. Compared with patients infected with penicillin-susceptible pneumococcal strains, patients whose isolates were nonsusceptible had a significantly greater risk of in-hospital death due to pneumonia (relative risk [RR], 2.1; 95% confidence interval [CI], 1-4.3) and suppurative complications of infection (RR, 4.5; 95% CI, 1-19.3), although only risk of suppurative complications remained statistically significant after adjustment for baseline differences in severity of illness. Among adults with bacteremic pneumococcal pneumonia, infection with penicillin-nonsusceptible pneumococci is associated with an increased risk of adverse outcome.
authors.affiliation: Veterans Affairs Medical Center and University of Pennsylvania School of Medicine, Philadelphia, PA, 19104, USA. jmetlay@cceb.med.upenn.edu
authors.forename: J P
authors.initials: JP
authors.lastname: Metlay
authors.forename: J
authors.initials: J
authors.lastname: Hofmann
authors.forename: M S
authors.initials: MS
authors.lastname: Cetron
authors.forename: M J
authors.initials: MJ
authors.lastname: Fine
authors.forename: M M
authors.initials: MM
authors.lastname: Farley
authors.forename: C
authors.initials: C
authors.lastname: Whitney
authors.forename: R F
authors.initials: RF
authors.lastname: Breiman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010406:Penicillins / Q000494:pharmacology* / Q000627:therapeutic use; D011018:Pneumonia, Pneumococcal / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013296:Streptococcus pneumoniae / Q000187:drug effects*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D010406:Penicillins