Effect of penicillin resistance of Streptococcus pneumoniae on the presentation, prognosis, and treatment of pneumococcal endocarditis in adults.
We performed a clinical study of pneumococcal endocarditis (PE) in adults at 15 major Spanish hospitals during a 21-year period (1978-1998). During this time, 63 patients had PE due to Streptococcus pneumoniae diagnosed. Of the 63 isolates recovered from these patients, 24 (38%) and 6 (10%) showed resistance to penicillin (minimum inhibitory concentration [MIC], 0.1-4 microg/mL) and cefotaxime (MIC, 1 microg/mL), respectively. Twenty-two (35%) of the patients died. Left-side heart failure, but not penicillin resistance, was independently associated with a higher risk of death (odds ratio, 1.33; 95% confidence interval, 1.04-1.71; P=.026). Patients without meningitis who had PE due to penicillin-resistant S. pneumoniae could be treated with high-dose penicillin or a third-generation cephalosporin if the MIC for penicillin was < or =1 microg/mL. For patients with concurrent meningitis, high doses of cefotaxime could be used if the MIC for cefotaxime was < or =1 microg/mL. Early recognition of heart failure and surgery may help to decrease mortality.
Martínez
Esteban
E
Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer, University of Barcelona, E-08036-Barcelona, Spain.
Miró
Jose M
JM
Almirante
Benito
B
Aguado
Jose M
JM
Fernandez-Viladrich
Pedro
P
Fernandez-Guerrero
Manuel L
ML
Villanueva
Jose L
JL
Dronda
Fernando
F
Moreno-Torrico
Alfonso
A
Montejo
Miguel
M
Llinares
Pedro
P
Gatell
Jose M
JM
D000328:Adult; D000368:Aged; D002439:Cefotaxime / Q000008:administration & dosage / Q000378:metabolism / Q000627:therapeutic use; D002511:Cephalosporins / Q000008:administration & dosage / Q000378:metabolism / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004697:Endocarditis, Bacterial / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000401:mortality; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010403:Penicillin Resistance; D010406:Penicillins / Q000008:administration & dosage / Q000378:metabolism* / Q000627:therapeutic use; D011008:Pneumococcal Infections / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies; D013030:Spain / Q000453:epidemiology; D013296:Streptococcus pneumoniae / Q000187:drug effects* / Q000302:isolation & purification*; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000209:etiology / Q000601:surgery
D002511:Cephalosporins; D010406:Penicillins; D002439:Cefotaxime