Effect of penicillin resistance of Streptococcus pneumoniae on the presentation, prognosis, and treatment of pneumococcal endocarditis in adults.

We performed a clinical study of pneumococcal endocarditis (PE) in adults at 15 major Spanish hospitals during a 21-year period (1978-1998). During this time, 63 patients had PE due to Streptococcus pneumoniae diagnosed. Of the 63 isolates recovered from these patients, 24 (38%) and 6 (10%) showed resistance to penicillin (minimum inhibitory concentration [MIC], 0.1-4 microg/mL) and cefotaxime (MIC, 1 microg/mL), respectively. Twenty-two (35%) of the patients died. Left-side heart failure, but not penicillin resistance, was independently associated with a higher risk of death (odds ratio, 1.33; 95% confidence interval, 1.04-1.71; P=.026). Patients without meningitis who had PE due to penicillin-resistant S. pneumoniae could be treated with high-dose penicillin or a third-generation cephalosporin if the MIC for penicillin was < or =1 microg/mL. For patients with concurrent meningitis, high doses of cefotaxime could be used if the MIC for cefotaxime was < or =1 microg/mL. Early recognition of heart failure and surgery may help to decrease mortality.

[1]  G. Campbell,et al.  Drug-resistant Streptococcus pneumoniae. , 1998, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[2]  Ellen Jo Baron,et al.  Manual of clinical microbiology , 1975 .

[3]  V. Quagliarello,et al.  Treatment of bacterial meningitis , 1999, Comprehensive therapy.

[4]  M. Cetron,et al.  Clinical outcomes of meningitis caused by Streptococcus pneumoniae in the era of antibiotic resistance. , 2000, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[5]  N. L. Johnson,et al.  Multivariate Analysis , 1958, Nature.

[6]  V. Caviness,et al.  Acute bacterial meningitis in adults. A review of 493 episodes. , 1993, The New England journal of medicine.

[7]  M. Bronze,et al.  Infective endocarditis caused by Streptococcus pneumoniae with high-level resistance to penicillin and cephalosporin. , 1996, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[8]  J. Viel,et al.  Mortality in pneumococcal meningitis: a multivariate analysis of prognostic factors. , 1993, The European journal of medicine.

[9]  J. Liñares,et al.  Decreased susceptibility of penicillin-resistant pnenmococci to twenty-four βlactam antibiotics , 1992 .

[10]  R. Norrby,et al.  Invasive pneumococcal infections: incidence, predisposing factors, and prognosis. , 1985, Reviews of infectious diseases.

[11]  R G Petersdorf,et al.  INFECTIVE ENDOCARDITIS: A REVIEW OF 125 CASES FROM THE UNIVERSITY OF WASHINGTON HOSPITALS, 1963–72 , 1977, Medicine.

[12]  M. Cetron,et al.  Increasing prevalence of multidrug-resistant Streptococcus pneumoniae in the United States. , 2000, The New England journal of medicine.

[13]  J. Pérez,et al.  Trends in antimicrobial resistance of clinical isolates of Streptococcus pneumoniae in Bellvitge Hospital, Barcelona, Spain (1979-1990). , 1992, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[14]  R Erbel,et al.  Identification of high-risk subgroups in infective endocarditis and the role of echocardiography. , 1995, European heart journal.

[15]  J. Ariza,et al.  Characteristics and antibiotic therapy of adult meningitis due to penicillin-resistant pneumococci. , 1988, The American journal of medicine.

[16]  C. Cabellos,et al.  Resistance to penicillin and cephalosporin and mortality from severe pneumococcal pneumonia in Barcelona, Spain. , 1995, The New England journal of medicine.

[17]  James J Schlesselman.  Case-Control Studies: Design, Conduct, Analysis , 1982 .

[18]  D. Durack,et al.  New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. , 1994, The American journal of medicine.

[19]  S. Bhattacharya.  Management of meningitis caused by penicillin-resistant Streptococcus pneumoniae , 1996, Antimicrobial agents and chemotherapy.

[20]  F. Soriano,et al.  Treatment of experimental endocarditis due to penicillin-resistant Streptococcus pneumoniae , 1994, Antimicrobial Agents and Chemotherapy.

[21]  W. Wilson.  Antibiotic treatment of infective endocarditis due to viridans streptococci, enterococci, and other streptococci. , 1998, Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases.

[22]  J. Pérez,et al.  Decreased susceptibility of penicillin-resistant pneumococci to twenty-four beta-lactam antibiotics. , 1992, The Journal of antimicrobial chemotherapy.

[23]  C. Cabellos,et al.  High doses of cefotaxime in treatment of adult meningitis due to Streptococcus pneumoniae with decreased susceptibilities to broad-spectrum cephalosporins , 1996, Antimicrobial agents and chemotherapy.

[24]  J. Mainardi,et al.  Streptococcus pneumoniae Endocarditis in Adults: A Multicenter Study in France in the Era of Penicillin Resistance (1991‐1998) , 2000, Medicine.

[25]  E. Bouza,et al.  Susceptibility of Streptococcus pneumoniae to penicillin: a prospective microbiological and clinical study. , 1992, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[26]  Mary Jane Ferraro,et al.  Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically : approved standard , 2000 .

[27]  Antibiotic treatment of adults with infective endocarditis due to streptococci, enterococci, staphylococci, and HACEK microorganisms. American Heart Association. , 1995, JAMA.

[28]  V. Fuster,et al.  Early identification of patients with native valve infectious endocarditis at risk for major complications by initial clinical presentation and baseline echocardiography. , 1995, International journal of cardiology.

[29]  O. Paulson,et al.  Pneumococcal meningitis: an evaluation of prognostic factors in 164 cases based on mortality and on a study of lasting sequelae. , 1985, The Journal of infection.

[30]  E. Bouza,et al.  Austrian syndrome caused by highly penicillin-resistant Streptococcus pneumoniae. , 1999, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[31]  J. Bartlett,et al.  A fresh look at the definition of susceptibility of Streptococcus pneumoniae to beta-lactam antibiotics. , 2001, Archives of internal medicine.

[32]  J. C. West,et al.  Review of pneumococcal endocarditis in adults in the penicillin era. , 1998, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[33]  M. Cetron,et al.  Impact of penicillin susceptibility on medical outcomes for adult patients with bacteremic pneumococcal pneumonia. , 2000, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[34]  A. Schuchat,et al.  Management of community-acquired pneumonia in the era of pneumococcal resistance: a report from the Drug-Resistant Streptococcus pneumoniae Therapeutic Working Group. , 2000, Archives of internal medicine.

[35]  A. Fenoll,et al.  Serotype distribution and antimicrobial resistance of Streptococcus pneumoniae isolates causing systemic infections in Spain, 1979-1989. , 1991, Reviews of infectious diseases.

[36]  C. Crumpacker,et al.  Infective endocarditis: an analysis based on strict case definitions. , 1981, Annals of internal medicine.

[37]  J. Dorca,et al.  Risk factors and response to antibiotic therapy in adults with bacteremic pneumonia caused by penicillin-resistant pneumococci. , 1987, The New England journal of medicine.

[38]  R. Haug.  New criteria for diagnosis of infective endocarditis: Utilization of specific echocardiographic findings , 1994 .

[39]  Sheldon L. Kaplan,et al.  Management of Infections Due to Antibiotic-Resistant Streptococcus pneumoniae , 1998, Clinical Microbiology Reviews.