title: Hospitalized community-acquired pneumonia due to Streptococcus pneumoniae: Has resistance to antibiotics decreased?
abstract: OBJECTIVE
  To determine the incidence and trends of pneumococcal community-acquired pneumonia (CAP) resistant to antibiotics, to describe clinical and microbiological features of pneumococcal CAP, and to ascertain prognostic risk factors in a third-level hospital.
  
  
  METHODS
  We performed a prospective study of all well-defined pneumococcal CAP hospitalizations in the Hospital Clínic de Barcelona (Spain) over 2 years of follow-up, and results were compared with a previous study.
  
  
  RESULTS
  One hundred twenty-five patients were included (mean age, 59.6 years; 71.2% male and 28.8% female). Mortality was 7% (n = 9). Twenty-four percent were HIV-1 seropositive (n = 30), and 53% had at least one comorbidity (n = 65). Nonsusceptibility to penicillin, ceftriaxone, and erythromycin accounted for 34%, 9%, and 33%, respectively. A decrease in penicillin (p = 0.01) and cephalosporin (p < 0.001) resistance was observed on comparison with a previous study, while macrolide resistance remained unchanged. Serotype 1 infection was overrepresented (8%, n = 10). A bad outcome was related to female gender (relative risk [RR], 9.1; confidence interval [CI], 1.3 to 61.3), pleural effusion (RR, 13.35; CI, 1.9 to 93.1), and prior oral corticoid intake (RR, 10.59; CI, 1.2 to 91.2), whereas drug-resistant strains were not.
  
  
  CONCLUSIONS
  We found a decrease in drug resistance compared with a previous report and a relatively high incidence of serotype 1 pneumococcal CAP. We also observed a high prevalence of HIV-1 infection among individuals with pneumococcal pneumonia. We confirm the lack of association of drug resistance with mortality and length of hospitalization. Mortality was associated with female gender, pleural effusion, and previous oral corticoid treatment. These results should be better ascertained in further studies.
authors.affiliation: Institut Clínic de Pneumologia i Cirurgia Toràcica, Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Vallès
authors.forename: Angeles
authors.initials: A
authors.lastname: Marcos
authors.forename: Mariona
authors.initials: M
authors.lastname: Pinart
authors.forename: Raquel
authors.initials: R
authors.lastname: Piñer
authors.forename: Francesc
authors.initials: F
authors.lastname: Marco
authors.forename: Josep Maria
authors.initials: JM
authors.lastname: Mensa
authors.forename: Antoni
authors.initials: A
authors.lastname: Torres
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000382:microbiology* / Q000401:mortality; D004198:Disease Susceptibility / Q000209:etiology; D024881:Drug Resistance, Bacterial / Q000187:drug effects; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D015994:Incidence; D018942:Macrolides / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011018:Pneumonia, Pneumococcal / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013296:Streptococcus pneumoniae / Q000187:drug effects / Q000472:pathogenicity*; D016019:Survival Analysis; D047090:beta-Lactams / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D018942:Macrolides; D047090:beta-Lactams