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 Original Articles |
| Clinical Characteristics of Bacteremic Pneumococcal Diseases Due to Penicillin-Resistant Streptococcus pneumoniae |
| Song JH, Chung DR, Kim EO, Kim YS, Woo JH, Kim S, Peck KR, Lee H, Lee NY, Ryu JS, Pai CH |
| Division of Infectious Diseases, Samsung Medical Center, Sung Kyun Kwan University, College of Medicine. Department of Clinical Pathology, Samsung Medical Center, Sung Kyun Kwan University, College of Medicine. Division of Infectious Diseases, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea. Department of Clinical Pathology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea. |
Vol.29 Num.4 (p277~285)
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BACKGROUND: The emergence of penicillin-resistant Streptococcus pneumoniae (PRSP) poses serious therapeutic problem in clinical practice, especially in cases with bacteremia or meningitis.
METHODS: To investigate clinical characteristics of bacteremic pneumococcal diseases due to PRSP, we retrospectively analyzed 41 cases with documented bacteremic diseases seen in a tertiary care hospital between 1989 and 1994.
RESULTS: Agar dilution test of 41 strains isolated showed that 68.3% of S. pneumoniae were PRSP [high-level resistance(R) 56.1%, intermediate resistance (I) 12.2%]. High-level resistant strains were not susceptible to other beta-lactam agents, whereas isolates of penicillin-susceptible S. pneumoniae (PSSP) were uniformly susceptible to all beta-lactam agents. Predominant serogroup of PRSP were 19, 23, and 6. Bacteremic diseases caused by PRSP included pneumonia (22), meningitis (5), peritonitis (3), acute otitis media (2), acute tonsillitis (2), endocarditis (1), pyelonephritis (1), and primary bacteremia (5). Children were more likely to be infected with PRSP with high-level or intermediately resistant strains than were adults (P=0.0001), but no differences were seen between PRSP and PSSP regarding sex, previous antibiotic history, previous hospitalization, and underlying immunocompromised conditions. Most cases were community-acquired (R 78.3%, I 60%, S 61.5%). Fatality rates of patients infected with PRSP were not different significantly from PSSP (22.6% vs. 30%). However, most fatal cases had underlying immunocompromised conditions.
CONCLUSION: PRSP is widely prevalent in Korea and shows resistance to most antibiotics. It causes community-acquired bacteremic diseases with poor outcomes, but there was no difference in mortality between patients infected with PRSP and PSSP. Pediatric age was the only risk factor for penicillin resistance.
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Keywords : Streptococcus pneumoniae, Resistance, Penicillin, Bacteremia |
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