Factors associated with penicillin-nonsusceptible pneumococcal infections in Brazil

Abstract

Resistance of Streptococcus pneumoniae is a worldwide, growing problem. Studies of factors associated with resistance to penicillin have not been conducted in Brazil. The objective of the present study was to evaluate factors associated with infection by S. pneumoniae not susceptible to penicillin. A prevalence study was conducted including all patients with a positive culture for S. pneumoniae in a hospital from July 1991 to December 1992 and the year 1994. Of 165 patients identified, 139 were considered to have clinically relevant infections and 88% of them had invasive infections. All infections were community acquired and consisted of pneumonia (44%) and of central nervous system (19%), pelvic or abdominal (12%), upper airway or ocular (12%), primary bloodstream (9%) and skin and soft tissue (5%) infections. Mortality was 25%. Susceptibility to penicillin was present in 77.6% of the isolates; 21.8% were relatively resistant, and one isolate was resistant (minimal inhibitory concentration = 4 µg/ml). Multivariate analysis showed that age below 4 years (odds ratio (OR): 3.53, 95% confidence interval (95%CI): 1.39-8.96) and renal failure (OR: 5.50, were associated with lack of susceptibility to penicillin. Bacteremia occurred significantly less frequently in penicillin-nonsusceptible infections (OR: 0.34, 95%CI: 0.14-0.84), possibly suggesting that lack of penicillin susceptibility is associated with lower virulence in S. pneumoniae.

Fluoroquinolone treatment as a protective factor for 10-day mortality in Streptococcus pneumoniae bacteremia in cancer patients

“…Overall, pneumococcal susceptibility to other antimicrobials remained similar to those found in the literature, except small decrease of susceptibility to CLI and ERY 21,23 . It was not possible to statistically estimate the protective effect of pneumococcal vaccination due to the small number of patients known to be vaccinated (n = 9).…”

“…Regarding antimicrobial susceptibility, our study presented a better susceptibility profile than other similar studies. Of all 141 strains tested, susceptibility to PEN was 79% (MIC ≤ 0.06 µg/mL) and 99% (MIC ≤ 2 µg/mL) which is higher than reported in the literature (74%, MIC ≤ 0.06 ug/mL 21 ), including among cancer patients (78% MIC ≤ 0.1 ug/mL 22 and 86% MIC ≤ 2 ug/mL 23 . In our study, no strains with high resistance to PEN were identified, and the MIC range was between 0.006 ug/mL and 4 ug/mL (median 0.016 ug/mL).…”

Fatores prognósticos em bacteremias por Streptococcus pneumoniae em pacientes com câncer

“…incluiu crianças e adultos, a mortalidade global por doença pneumocócica foi de 25%, sendo 33% em adultos e 14% em crianças (19).…”

“…Pittet et al demonstraram em 1993 (195) (192,194) No presente estudo, neutropenia vigente foi fator de risco para mortalidade em 10 dias (OR 4,01; p 0,011) na análise multivariada. (48,197,198), maior as implicadas nas DPIs, característica relacionada com maior virulência em alguns estudos (19) e maior incidência de neutropenia em relação a outros estudos prévios.…”

Avaliação da efetividade da vacina antipneumocócica 10 valente na redução da doença pneumocócica invasiva em crianças brasileiras : estudo caso controle multicêntrico

“…Neste sentido, os sorotipos prevalentes identificados variam com a idade do paciente, a síndrome clínica, a área geográfica e ao longo do tempo (HAUSDORFF et al, 2000;FEIKIN;KLUGMAN, 2005 A resistência do pneumococo aos antimicrobianos, como betalactâmicos (penicilinas e cefalosporinas), trimetoprim-sulfametoxazol, macrolídeos e quinolonas também constitui um problema crescente em todo o mundo, inclusive no Brasil. Particularmente em países em que o uso de antibióticos é amplo e indiscriminado, a presença de resistência constitui-se em problema de relevância ao acarretar aumento da letalidade e dos custos do tratamento (ROSSI et al, 2001;LAVAL et al, 2006;LEVIN et al, 2003).…”