Resistance to penicillin and cephalosporin and mortality from severe pneumococcal pneumonia in Barcelona, Spain

Background: Penicillin-resistant strains of Streptococcus pneumoniae are now found worldwide, and strains with resistance to cephalosporin are being reported. The appropriate antibiotic therapy for pneumococcal pneumonia due to resistant strains remains controversial. Methods: To examine the effect...

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Authors: Pallarés Giner, Roman, Liñares Louzao, Josefina, Vadillo, Miquel, Cabellos Mínguez, Ma. Carmen, Manresa, Federico, Viladrich, Pedro F., Martín, Rogelio, Gudiol i Munté, Francesc
Format: article
Status:Published version
Publication Date:1995
Country:España
Institution:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
Repository:Recercat. Dipósit de la Recerca de Catalunya
OAI Identifier:oai:recercat.cat:2445/122614
Online Access:https://hdl.handle.net/2445/122614
Access Level:Open access
Keyword:Penicil·lina
Estreptococs
Cefalosporines
Medicaments antibacterians
Barcelona (Catalunya)
Penicillin
Streptococcus
Cephalosporines
Antibacterial agents
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spelling Resistance to penicillin and cephalosporin and mortality from severe pneumococcal pneumonia in Barcelona, SpainPallarés Giner, RomanLiñares Louzao, JosefinaVadillo, MiquelCabellos Mínguez, Ma. CarmenManresa, FedericoViladrich, Pedro F.Martín, RogelioGudiol i Munté, FrancescPenicil·linaEstreptococsCefalosporinesMedicaments antibacteriansBarcelona (Catalunya)PenicillinStreptococcusCephalosporinesAntibacterial agentsBackground: Penicillin-resistant strains of Streptococcus pneumoniae are now found worldwide, and strains with resistance to cephalosporin are being reported. The appropriate antibiotic therapy for pneumococcal pneumonia due to resistant strains remains controversial. Methods: To examine the effect of resistance to penicillin and cephalosporin on mortality, we conducted a 10-year, prospective study in Barcelona of 504 adults with culture-proved pneumococcal pneumonia. Results: Among the 504 patients, 145 (29 percent) had penicillin-resistant strains of S. pneumoniae (minimal inhibitory concentration [MIC] of penicillin G, 0.12 to 4.0 μg per milliliter), and 31 patients (6 percent) had cephalosporin-resistant strains (MIC of ceftriaxone or cefotaxime, 1.0 to 4.0 μg per milliliter). Mortality was 38 percent in patients with penicillin-resistant strains, as compared with 24 percent in patients with penicillin-sensitive strains (P = 0.001). However, after the exclusion of patients with polymicrobial pneumonia and adjustment for other predictors of mortality, the odds ratio for mortality in patients with penicillin-resistant strains was 1.0 (95 percent confidence interval, 0.5 to 1.9; P = 0.84). Among patients treated with penicillin G or ampicillin, the mortality was 25 percent in the 24 with penicillin-resistant strains and 19 percent in the 126 with penicillin-sensitive strains (P = 0.51). Among patients treated with ceftriaxone or cefotaxime, the mortality was 22 percent in the 59 with penicillin-resistant strains and 25 percent in the 127 with penicillin-sensitive strains (P = 0.64). The frequency of resistance to cephalosporin increased from 2 percent in 1984-1988 to 9 percent in 1989-1993 (P = 0.002). Mortality was 26 percent in patients with cephalosporin-resistant S. pneumoniae and 28 percent in patients with susceptible organisms (P = 0.89). Among patients treated with ceftriaxone or cefotaxime, mortality was 22 percent in the 18 with cephalosporin-resistant strains and 24 percent in the 168 with cephalosporin-sensitive organisms (P = 0.64). Conclusions: Current levels of resistance to penicillin and cephalosporin by S. pneumoniae are not associated with increased mortality in patients with pneumococcal pneumonia. Hence, these antibiotics remain the therapy of choice for this disease.Massachusetts Medical Society2018201819952018info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersion7 p.application/pdfhttps://hdl.handle.net/2445/122614Articles publicats en revistes (Ciències Clíniques)reponame:Recercat. Dipósit de la Recerca de Catalunyainstname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)InglésReproducció del document publicat a: https://doi.org/10.1056/NEJM199508243330802New England Journal of Medicine, 1995, vol. 333, num. 8, p. 474-480https://doi.org/10.1056/NEJM199508243330802(c) Massachusetts Medical Society, 1995info:eu-repo/semantics/openAccessoai:recercat.cat:2445/1226142026-05-29T05:05:01Z
dc.title.none.fl_str_mv Resistance to penicillin and cephalosporin and mortality from severe pneumococcal pneumonia in Barcelona, Spain
title Resistance to penicillin and cephalosporin and mortality from severe pneumococcal pneumonia in Barcelona, Spain
spellingShingle Resistance to penicillin and cephalosporin and mortality from severe pneumococcal pneumonia in Barcelona, Spain
Pallarés Giner, Roman
Penicil·lina
Estreptococs
Cefalosporines
Medicaments antibacterians
Barcelona (Catalunya)
Penicillin
Streptococcus
Cephalosporines
Antibacterial agents
title_short Resistance to penicillin and cephalosporin and mortality from severe pneumococcal pneumonia in Barcelona, Spain
title_full Resistance to penicillin and cephalosporin and mortality from severe pneumococcal pneumonia in Barcelona, Spain
title_fullStr Resistance to penicillin and cephalosporin and mortality from severe pneumococcal pneumonia in Barcelona, Spain
title_full_unstemmed Resistance to penicillin and cephalosporin and mortality from severe pneumococcal pneumonia in Barcelona, Spain
title_sort Resistance to penicillin and cephalosporin and mortality from severe pneumococcal pneumonia in Barcelona, Spain
dc.creator.none.fl_str_mv Pallarés Giner, Roman
Liñares Louzao, Josefina
Vadillo, Miquel
Cabellos Mínguez, Ma. Carmen
Manresa, Federico
Viladrich, Pedro F.
Martín, Rogelio
Gudiol i Munté, Francesc
author Pallarés Giner, Roman
author_facet Pallarés Giner, Roman
Liñares Louzao, Josefina
Vadillo, Miquel
Cabellos Mínguez, Ma. Carmen
Manresa, Federico
Viladrich, Pedro F.
Martín, Rogelio
Gudiol i Munté, Francesc
author_role author
author2 Liñares Louzao, Josefina
Vadillo, Miquel
Cabellos Mínguez, Ma. Carmen
Manresa, Federico
Viladrich, Pedro F.
Martín, Rogelio
Gudiol i Munté, Francesc
author2_role author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Penicil·lina
Estreptococs
Cefalosporines
Medicaments antibacterians
Barcelona (Catalunya)
Penicillin
Streptococcus
Cephalosporines
Antibacterial agents
topic Penicil·lina
Estreptococs
Cefalosporines
Medicaments antibacterians
Barcelona (Catalunya)
Penicillin
Streptococcus
Cephalosporines
Antibacterial agents
description Background: Penicillin-resistant strains of Streptococcus pneumoniae are now found worldwide, and strains with resistance to cephalosporin are being reported. The appropriate antibiotic therapy for pneumococcal pneumonia due to resistant strains remains controversial. Methods: To examine the effect of resistance to penicillin and cephalosporin on mortality, we conducted a 10-year, prospective study in Barcelona of 504 adults with culture-proved pneumococcal pneumonia. Results: Among the 504 patients, 145 (29 percent) had penicillin-resistant strains of S. pneumoniae (minimal inhibitory concentration [MIC] of penicillin G, 0.12 to 4.0 μg per milliliter), and 31 patients (6 percent) had cephalosporin-resistant strains (MIC of ceftriaxone or cefotaxime, 1.0 to 4.0 μg per milliliter). Mortality was 38 percent in patients with penicillin-resistant strains, as compared with 24 percent in patients with penicillin-sensitive strains (P = 0.001). However, after the exclusion of patients with polymicrobial pneumonia and adjustment for other predictors of mortality, the odds ratio for mortality in patients with penicillin-resistant strains was 1.0 (95 percent confidence interval, 0.5 to 1.9; P = 0.84). Among patients treated with penicillin G or ampicillin, the mortality was 25 percent in the 24 with penicillin-resistant strains and 19 percent in the 126 with penicillin-sensitive strains (P = 0.51). Among patients treated with ceftriaxone or cefotaxime, the mortality was 22 percent in the 59 with penicillin-resistant strains and 25 percent in the 127 with penicillin-sensitive strains (P = 0.64). The frequency of resistance to cephalosporin increased from 2 percent in 1984-1988 to 9 percent in 1989-1993 (P = 0.002). Mortality was 26 percent in patients with cephalosporin-resistant S. pneumoniae and 28 percent in patients with susceptible organisms (P = 0.89). Among patients treated with ceftriaxone or cefotaxime, mortality was 22 percent in the 18 with cephalosporin-resistant strains and 24 percent in the 168 with cephalosporin-sensitive organisms (P = 0.64). Conclusions: Current levels of resistance to penicillin and cephalosporin by S. pneumoniae are not associated with increased mortality in patients with pneumococcal pneumonia. Hence, these antibiotics remain the therapy of choice for this disease.
publishDate 1995
dc.date.none.fl_str_mv 1995
2018
2018
2018
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/122614
url https://hdl.handle.net/2445/122614
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a: https://doi.org/10.1056/NEJM199508243330802
New England Journal of Medicine, 1995, vol. 333, num. 8, p. 474-480
https://doi.org/10.1056/NEJM199508243330802
dc.rights.none.fl_str_mv (c) Massachusetts Medical Society, 1995
info:eu-repo/semantics/openAccess
rights_invalid_str_mv (c) Massachusetts Medical Society, 1995
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv 7 p.
application/pdf
dc.publisher.none.fl_str_mv Massachusetts Medical Society
publisher.none.fl_str_mv Massachusetts Medical Society
dc.source.none.fl_str_mv Articles publicats en revistes (Ciències Clíniques)
reponame:Recercat. Dipósit de la Recerca de Catalunya
instname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
instname_str Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
reponame_str Recercat. Dipósit de la Recerca de Catalunya
collection Recercat. Dipósit de la Recerca de Catalunya
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,812429

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