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Cited by 451Pneumonia and Respiratory InfectionsAntibiotic Resistance in BacteriaBacterial Identification and Susceptibility Testing

An International Prospective Study of Pneumococcal Bacteremia: Correlation with In Vitro Resistance, Antibiotics Administered, and Clinical Outcome

Yu, V. L., Chiou, C. C. C., Feldman, C., Ortqvist, A., Rello, J., Morris, A. J., Baddour, L. M., Luna, C. M. +7 more·2003·Clinical Infectious Diseases
DOI 10.1086/377534
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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.

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  1. [2]2. Charles Feldman (principal investigator), Keith P. Klugman (co-principal investigator), Anne von Gottberg, Xoliswa Poswa, and Rajen Morar. Spain. University Hospital Joan XXIII, Tarragona: Jordi Rello (principal investigator), Emili Diaz, and Jose M. Santa- maria; Corporacio Sanitaria Parc Tauli, Sabadell: Dolous Mar- iscal, Dionisa Fontanals, M. Lujan, and Miquel Gallego. Sweden. Karolinska Hospital, Stockholm: Ake Ortqvist (principal investigator) and Margareta Rylander. Taiwan. Tri-Service General Hospital, Taipei: Feng-Yee Chang (principal investigator). National Cheng Kung University Hospital, Tainan: Wen-Chien Ko (principal investigator). St. Martin De Porres Hospital: Wen-Pin Wu and Chia Yi. United States. New England Medical Center, Boston: David R. Snydman (principal investigator), Laurie Barefoot, and Laura McDermott. National Naval Medical Center, Bethesda, Mary- land: David L. Blazes and Gregory Marin. University of Tennessee Medical Center, Knoxville: Larry M. Baddour (principal inves- tigator), Madana Mobasseri. University of Pittsburgh and Vet- erans Affairs Medical Center, Pittsburgh: Victor L. Yu (principal investigator), Dong Hoon Daniel Kim, and John D. Rihs. References 1. Chen DK, McGeer A, de Azavedo JC, Low DE. Decreased susceptibility of Streptococcus pneumoniae to fluoroquinolones in Canada. N Engl J Med 1999; 341:233-9.
  2. [16]16. Henriques B, Kalin M, Ortqvist A, et al. Molecular epidemiology of Streptococcus pneumoniae causing invasive disease in 5 countries. J Infect Dis 2000; 182:833-9.
  3. [34]34. Craig WA. Pharmacokinetic/pharmacodynamic parameters: rationale for antibacterial dosing of mice and men. Clin Infect Dis 1998; 26:1-12.
  4. [40]40. Baddour LM, Smith EA. Multidrug resistance among Streptococcus pneumoniae in the United States. Clin Infect Dis 1999; 29:224-5.
  5. [41]41. Bartlett JG, Dowell SF, Mandell LA, File TM, Musher DM, Fine MJ. Practice guidelines for management of community-acquired pneu- monia. Clin Infect Dis 2000; 31:347-82.

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Authors
Yu, V. L., Chiou, C. C. C., Feldman, C., Ortqvist, A., Rello, J., Morris, A. J., Baddour, L. M., Luna, C. M., Snydman, D. R., Ip, M., Ko, W. C., Chedid, M. B. F., Andremont, A., Klugman, K. P., & International Pneumococcal Study Group
Affiliations
  • University of Pittsburgh (US)
  • Kaohsiung Veterans General Hospital (TW)
  • University of the Witwatersrand (ZA)
  • Hospital Universitari Joan XXIII de Tarragona (ES)
  • Mayo Clinic (US)
  • Universidad de Buenos Aires (AR)
  • Tufts University (US)
  • Chinese University of Hong Kong (HK)
  • National Cheng Kung University Hospital (TW)
  • Universidade Federal do Rio Grande do Sul (BR)
  • Assistance Publique – Hôpitaux de Paris (FR)
  • National Health Laboratory Service (ZA)
Corresponding author
Yu, V. L.
ORCID
Venue
Clinical Infectious Diseases
Publisher
Oxford University Press (OUP)
Published
2003-07-15
Volume
37
Issue
2
Pages
230-237
ISSN
  • 1058-4838 (ISSN-L)
  • 1537-6591
DOI
10.1086/377534
OpenAlex
W2169455258
Cited by
451
References
44
Citations by year
2026: 1 · 2025: 4 · 2024: 8 · 2023: 2 · 2022: 11 · 2021: 15 · 2020: 13 · 2019: 13 · 2018: 7 · 2017: 10 · 2016: 14 · 2015: 20 · 2014: 19 · 2013: 9 · 2012: 23
FWCI
26.43
Type
journal article
Language
en
Open access
closed
Locations
  • Clinical Infectious Diseases (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Abbott Laboratories
  • Pfizer
Topics
  • Health Sciences › Medicine › Epidemiology › Pneumonia and Respiratory Infections
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Medicine › Antibiotic Resistance in Bacteria
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Bacterial Identification and Susceptibility Testing
Keywords
pneumococcal bacteremia, Streptococcus pneumoniae, penicillin resistance, beta-lactam antibiotics, cefotaxime, ceftriaxone, cefuroxime, mortality, immunosuppression, defervescence, suppurative complications, hospitalized patients
MeSH terms
Adolescent, Adult, Aged, Aged, 80 and over, Anti-Bacterial Agents, Humans, Microbial Sensitivity Tests, Middle Aged, Penicillin Resistance, Penicillins, Pneumococcal Infections, Prospective Studies, Risk Factors, Statistics as Topic, Streptococcus pneumoniae, Bacteremia, Treatment Outcome, Drug Resistance, Bacterial

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