An international prospective study of pneumococcal bacteremia: Correlation with in vitro resistance, antibiotics administered, and clinical outcome

Victor L. Yu, Christine C.C. Chiou, Charles Feldman, Ake Ortqvist, Jordi Rello, Arthur J. Morris, Larry M. Baddour, Carlos M. Luna, David R. Snydman, Margaret Ip, Wen Chien Ko, M. Bernadete F. Chedid, Antoine Andremont, Keith P. Klugman

Research output: Contribution to journalArticle

362 Citations (Scopus)

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 μg/mL), and 9.6% of isolates were resistant (MIC, ≥2 μg/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 penicilllns, 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 β-lactam antibiotic therapy. β-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.

Original languageEnglish
Pages (from-to)230-237
Number of pages8
JournalClinical Infectious Diseases
Volume37
Issue number2
DOIs
Publication statusPublished - 2003 Jul 15

All Science Journal Classification (ASJC) codes

  • Microbiology (medical)
  • Infectious Diseases

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