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

作者：Victor L. Yu, Christine C. Chiou, Charles H. Feldman, Åke Örtqvist, Jordi Rello, Arthur J. Morris, Larry M. Baddour, Carlos M. Luna, David R. Snydman, Margaret Ip, Wen‐Chien Ko, Maria Bernadete Fernandes Chedid, Antoine Andremont, Keith P. Klugman, International Pneumococcal Study Group · 发表于：Clinical Infectious Diseases · 年份：2003 · DOI：10.1086/377534 · 被引用次数：460 · 研究领域：Pneumonia and Respiratory Infections、Bacterial Infections and Vaccines、Antibiotics Pharmacokinetics and Efficacy

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.