Tuberc Respir Dis.  1999 Aug;47(2):184-194. 10.4046/trd.1999.47.2.184.

Clinical Characteristics of Pneumococcal Bacteremia in Adults: The Effect of Penicillin Resistance on the Mortality of Patients with Pneumococcal Bacteremia

• Hwangbo B
• Yoon HI
• Lee SM
• Choi SH
• Yoo CG
• Lee CT
• Kim YW
• Han SK
• Min KU
• Kim YY
• Shim YS

• KMID: 2050173
• DOI: http://doi.org/10.4046/trd.1999.47.2.184

Abstract

BACKGROUNDS: The advent of penicillin has led to the marked reduction in the mortality from pneumococcal bacteremia, however, the mortality is still relatively high in this post-antibiotic era. Actually the prevalence of infection due to penicillin-resistant penumococci is increasing worldwide, and it is especially high in Korea due to irrelevant use of antibiotics. So, the high mortality of pneumococcal sepsis might be related to the emergence of penicillin-resistant strains, however, many other antibiotics, which eradicate pneumococci effectively, are available in these days. This has led us to suspect the role of penicillin- resistance in the high mortality rate. In this study, we evaluated the effect of penicillin resistance on the mortality of patients with penumococcal bacteremia.
METHODS
The study population consisted of 50 adult patients with penumococcal bacteremia who were admitted between Jan, 1990 and July, 1997. Medical records were analyzed retrospectively.
RESULTS
Most of the patients (96%) had underlying diseases. The most common local disease associated with pneumococcal bacteremia was pneumonia (42%), which was followed by spontaneous bacterial peritonitis (14%), cholangitis (10%), meningitis (8%), liver abscess (4%), pharyngotonsillitis (4%), sinusitis (2%) and cellulitis (2%). While the overall case-fatality rate in this study was 24%, it was higher when peumococcal bacteremia was associated with pneumonia (42%) or meningitis (50%). The rate of penicillin resistance was 40%, which was increased rapidly from 1991. The rate of penicillin resistance was significantly higher in patients with the history of recent antibiotics use and hospitalization within 3 months respectively. The clinical manifestations, that is, age, severity of underlying diseases, nosocomial infection, associated local diseases, and the presence of shock or acute renal failure were not statistically different between the patients with penicillin- resistant and -sensitive pneumococcal bacteremia. The mortality of patients infected with penicillin-resistant pneumococci was not statistically different from those with penicillin-sensitive pneumococcal bacteremia.
CONCLUSION
Penicillin resistance is not associated with high mortality in adult patients with pneumococcal bacteremia. As the overall mortality is high, active penumococcal vaccination is recommended in patients with high risk of infection.

Keyword

Streptococcus pneumoniae; Bacteremia; Mortality; Penicillin resistance

MeSH Terms

Acute Kidney Injury
Adult*
Anti-Bacterial Agents
Bacteremia*
Cellulitis
Cholangitis
Cross Infection
Hospitalization
Humans
Korea
Liver Abscess
Medical Records
Meningitis
Mortality*
Penicillin Resistance*
Penicillins*
Peritonitis
Pneumonia
Prevalence
Retrospective Studies
Sepsis
Shock
Sinusitis
Streptococcus pneumoniae
Vaccination
Anti-Bacterial Agents
Penicillins