title: Clinical outcomes of bacteremic pneumococcal pneumonia in the era of antibiotic resistance.
abstract: Limited data are available about the impact of antimicrobial resistance on clinical outcomes in cases of pneumococcal pneumonia. This was studied in 146 persons hospitalized with invasive pneumonia due to Streptococcus pneumoniae (minimum inhibitory concentration of cefotaxime, > or = .25 microg/mL) who were identified through population-based active surveillance for the period of November 1994 through April 1996. Compared with matched control subjects who had infection with more-susceptible S. pneumoniae, the proportion of subjects who died or who were admitted to an intensive care unit did not differ significantly. Multivariable analysis showed no significant contribution of antimicrobial resistance to mortality or the requirement for care in an intensive care unit. The ability to detect an effect of antimicrobial resistance on these important outcome measures may have been influenced by aggressive multidrug empirical therapy in this group of hospitalized patients. Factors other than resistance, such as severity of illness at presentation and advance directive status ("do not resuscitate" orders), appear to have a stronger influence on pneumococcal pneumonia outcomes.
authors.affiliation: Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
authors.forename: J F
authors.initials: JF
authors.lastname: Moroney
authors.forename: A E
authors.initials: AE
authors.lastname: Fiore
authors.forename: L H
authors.initials: LH
authors.lastname: Harrison
authors.forename: J E
authors.initials: JE
authors.lastname: Patterson
authors.forename: M M
authors.initials: MM
authors.lastname: Farley
authors.forename: J H
authors.initials: JH
authors.lastname: Jorgensen
authors.forename: M
authors.initials: M
authors.lastname: Phelan
authors.forename: R R
authors.initials: RR
authors.lastname: Facklam
authors.forename: M S
authors.initials: MS
authors.lastname: Cetron
authors.forename: R F
authors.initials: RF
authors.lastname: Breiman
authors.forename: M
authors.initials: M
authors.lastname: Kolczak
authors.forename: A
authors.initials: A
authors.lastname: Schuchat
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology; D016022:Case-Control Studies; D002439:Cefotaxime / Q000008:administration & dosage / Q000494:pharmacology; D018550:Cephalosporin Resistance; D002648:Child; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000382:microbiology; D006760:Hospitalization; D006801:Humans; D008875:Middle Aged; D011018:Pneumonia, Pneumococcal / Q000188:drug therapy* / Q000382:microbiology; D013296:Streptococcus pneumoniae / Q000187:drug effects / Q000302:isolation & purification; D016896:Treatment Outcome
chemical_list: D002439:Cefotaxime