Community-acquired bacteraemic pneumococcal pneumonia in adults: effect of diminished penicillin susceptibility on clinical outcome.
Pneumococcal pneumonia remains a common disease with a high mortality rate. Between 1995 and 2000, we prospectively analyzed 95 consecutive adult cases of community-acquired bacteraemic pneumococcal pneumonia treated in a single centre. The incidence of pneumococcal resistance to penicillin increased from 19 to 50% during the study period. Multivariate analysis showed that only age and recent hospitalization were independently associated with fatal outcome. The proportion of penicillin-resistant strains was slightly but not significantly higher among patients who died before the fourth hospital day than among those who died later. Patients who died before D4 were more likely to have a recent history of hospitalization, cancer and/or chemotherapy. It thus appears that infection by a resistant pneumococcal strain is not in itself a gravity factor in this setting, but that their acquisition is associated with pejorative clinical features.
Department of Infectious diseases, Université Pierre et Marie Curie, Hôpital Tenon (AP-HP), 4 rue de la Chine, 75020 Paris, France. philippe.bonnard@tnn.ap-hop-paris.fr
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Bonnard
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Lescure
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Douadi
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Schmit
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Jounieaux
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Laurans
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Ducroix
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010403:Penicillin Resistance; D011008:Pneumococcal Infections / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D011018:Pneumonia, Pneumococcal / Q000188:drug therapy / Q000401:mortality*; D011446:Prospective Studies; D013296:Streptococcus pneumoniae / Q000187:drug effects*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents