title: Factors associated with antimicrobial resistance and mortality in pneumococcal bacteremia.
abstract: We conducted a multicenter, retrospective cohort study of patients with Streptococcus pneumoniae bacteremia to determine factors associated with antibiotic resistance and mortality. Risk factors were identified using multivariate logistic regression. There were 1574 patients at 34 sites enrolled. Compared to isolates from patients not receiving an antibiotic before the index blood culture, patients receiving an antibiotic were less likely to harbor an antibiotic susceptible organism. Susceptibility to penicillin decreased from 78% (95% confidence interval [CI] 75-80) to 49% (95% CI 39-59); to cefotaxime/ceftriaxone, from 92% (95% CI 90-93) to 82% (95% CI 72-89); and to macrolide, from 84% (95% CI 82-87) to 55% (95% CI 41-68). Factors associated with macrolide non-susceptibility include: > 24 h of antibiotic therapy at time of the index culture (odds ratio [OR] 4.0), residing in southern U.S. (OR 1.7), and having an antibiotic allergy (OR 1.7). Harboring an antibiotic non-susceptible strain (OR 1.4) and male sex (OR 1.4) were associated with increased risk of mortality, whereas black race (OR 0.6) and evidence of focal infection (OR 0.6) were associated with decreased risk.
authors.affiliation: Division of Emergency Medicine, Children's Hospital, Boston, Massachusetts 02115, USA.
authors.forename: Mark I
authors.initials: MI
authors.lastname: Neuman
authors.forename: Meera
authors.initials: M
authors.lastname: Kelley
authors.forename: Marvin B
authors.initials: MB
authors.lastname: Harper
authors.forename: Thomas M
authors.initials: TM
authors.lastname: File
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016470:Bacteremia / Q000188:drug therapy* / Q000401:mortality; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000188:drug therapy; D004342:Drug Hypersensitivity; D024901:Drug Resistance, Multiple, Bacterial / Q000187:drug effects*; D005260:Female; D006801:Humans; D018942:Macrolides / Q000494:pharmacology; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D016017:Odds Ratio; D011008:Pneumococcal Infections / Q000188:drug therapy* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents; D018942:Macrolides