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

Esteban Martínez; Jose M Miró; Benito Almirante; Jose M Aguado; Pedro Fernandez-Viladrich; Manuel L Fernandez-Guerrero; Jose L Villanueva; Fernando Dronda; Alfonso Moreno-Torrico; Miguel Montejo; Pedro Llinares; Jose M Gatell; Spanish Pneumococcal Endocarditis Study Group

doi:10.1086/341024

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

Clin Infect Dis. 2002 Jul 15;35(2):130-9. doi: 10.1086/341024. Epub 2002 Jun 24.

Authors

Esteban Martínez¹, Jose M Miró, Benito Almirante, Jose M Aguado, Pedro Fernandez-Viladrich, Manuel L Fernandez-Guerrero, Jose L Villanueva, Fernando Dronda, Alfonso Moreno-Torrico, Miguel Montejo, Pedro Llinares, Jose M Gatell; Spanish Pneumococcal Endocarditis Study Group

Affiliation

¹ Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer, University of Barcelona, E-08036-Barcelona, Spain.

PMID: 12087518
DOI: 10.1086/341024

Abstract

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.

Publication types

Multicenter Study

MeSH terms

Adult
Aged
Cefotaxime / administration & dosage
Cefotaxime / metabolism
Cefotaxime / therapeutic use
Cephalosporins / administration & dosage
Cephalosporins / metabolism
Cephalosporins / therapeutic use
Dose-Response Relationship, Drug
Drug Administration Schedule
Endocarditis, Bacterial / complications
Endocarditis, Bacterial / diagnosis*
Endocarditis, Bacterial / drug therapy*
Endocarditis, Bacterial / epidemiology
Female
Heart Failure / etiology
Heart Failure / mortality
Humans
Male
Microbial Sensitivity Tests
Middle Aged
Penicillin Resistance*
Penicillins / administration & dosage
Penicillins / metabolism*
Penicillins / therapeutic use
Pneumococcal Infections / complications
Pneumococcal Infections / diagnosis*
Pneumococcal Infections / drug therapy*
Pneumococcal Infections / epidemiology
Prognosis
Prospective Studies
Spain / epidemiology
Streptococcus pneumoniae / drug effects*
Streptococcus pneumoniae / isolation & purification*
Treatment Outcome
Ventricular Dysfunction, Left / complications
Ventricular Dysfunction, Left / etiology
Ventricular Dysfunction, Left / surgery

Substances

Cephalosporins
Penicillins
Cefotaxime