Drug-resistant pneumococcal pneumonia:: Clinical relevance and related factors

A multicenter study of 638 cases of community-acquired pneumonia due to Streptococcus pneumoniae (SPCAP) was performed to assess current levels of resistance. Of the pneumococcal strains, 35.7% had an minimum inhibitory concentration ( MIC) of penicillin of greater than or equal to 0.12 mug/mL ( 3 isolates had an MIC of 4 mug/mL), 23.8% had an MIC of erythromycin of 128 mug/mL, and 22.2% were multidrug resistant. Logistic regression determined that chronic pulmonary disease (odds ratio [OR], 1.44], human immunodeficiency virus infection (OR, 1.98), clinically suspected aspiration (OR, 2.12), and previous hospital admission (OR, 1.69) were related to decreased susceptibility to penicillin, and previous admission (OR, 1.89) and an MIC of penicillin of MIC greater than or equal to0.12 mug/mL (OR, 15.85) were related to erythromycin resistance (MIC, greater than or equal to1 mug/mL). The overall mortality rate was 14.4%. Disseminated intravascular coagulation, empyema, and bacteremia were significantly more frequent among patients with penicillin-susceptible SP-CAP. Among isolates with MICs of penicillin of greater than or equal to0.12 mug/mL, serotype 19 was predominant and was associated with a higher mortality rate. In summary, the rate of resistance to beta-lactams and macrolides among S. pneumoniae that cause CAP remains high, but such resistance does not result in increased morbidity.