title: An international prospective study of pneumococcal bacteremia: correlation with in vitro resistance, antibiotics administered, and clinical outcome.
abstract: We performed a prospective, international, observational study of 844 hospitalized patients with blood cultures positive for Streptococcus pneumoniae. Fifteen percent of isolates had in vitro intermediate susceptibility to penicillin (minimum inhibitory concentration [MIC], 0.12-1 microg/mL), and 9.6% of isolates were resistant (MIC, >or=2 microg/mL). Age, severity of illness, and underlying disease with immunosuppression were significantly associated with mortality; penicillin resistance was not a risk factor for mortality. The impact of concordant antibiotic therapy (i.e., receipt of a single antibiotic with in vitro activity against S. pneumoniae) versus discordant therapy (inactive in vitro) on mortality was assessed at 14 days. Discordant therapy with penicillins, cefotaxime, and ceftriaxone (but not cefuroxime) did not result in a higher mortality rate. Similarly, time required for defervescence and frequency of suppurative complications were not associated with concordance of beta-lactam antibiotic therapy. beta-Lactam antibiotics should still be useful for treatment of pneumococcal infections that do not involve cerebrospinal fluid, regardless of in vitro susceptibility, as determined by current NCCLS breakpoints.
authors.affiliation: Division of Infectious Disease, University of Pittsburgh, PA, USA. vly+@pitt.edu
authors.forename: Victor L
authors.initials: VL
authors.lastname: Yu
authors.forename: Christine C C
authors.initials: CC
authors.lastname: Chiou
authors.forename: Charles
authors.initials: C
authors.lastname: Feldman
authors.forename: Ake
authors.initials: A
authors.lastname: Ortqvist
authors.forename: Jordi
authors.initials: J
authors.lastname: Rello
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Morris
authors.forename: Larry M
authors.initials: LM
authors.lastname: Baddour
authors.forename: Carlos M
authors.initials: CM
authors.lastname: Luna
authors.forename: David R
authors.initials: DR
authors.lastname: Snydman
authors.forename: Margaret
authors.initials: M
authors.lastname: Ip
authors.forename: Wen Chien
authors.initials: WC
authors.lastname: Ko
authors.forename: M Bernadete F
authors.initials: MB
authors.lastname: Chedid
authors.forename: Antoine
authors.initials: A
authors.lastname: Andremont
authors.forename: Keith P
authors.initials: KP
authors.lastname: Klugman
mesh_terms: D000293:Adolescent; 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; D024881:Drug Resistance, Bacterial; D006801:Humans; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010403:Penicillin Resistance / Q000502:physiology*; D010406:Penicillins / Q000494:pharmacology* / Q000627:therapeutic use; D011008:Pneumococcal Infections / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D011446:Prospective Studies; D012307:Risk Factors; D013223:Statistics as Topic; D013296:Streptococcus pneumoniae / Q000187:drug effects*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D010406:Penicillins