Failure of Treatment of Pneumonia Associated with Highly Resistant Pneumococci in a Child

Dowell, Scott F.; Smith, T. A.; Leversedge, Kimberly; Snitzer, Joseph

doi:10.1086/588389

Cited by 54 publications

(26 citation statements)

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“…However, a few cases of clinically observed treatment failure by ␤-lactam antibiotics in pneumonia due to PRSP have been reported despite an epidemic of PRSP. 31,32 We found only three cases of treatment failure for CAP due to PISP (two cases) and PRSP (one case) by short-term parenteral ampicillin therapy despite a very high frequency of penicillin-resistance in isolated S. pneumoniae strains. In addition, the rate of ␤-lactamase production in H. influenzae (75%) in our study was also higher than that in other parts of the world.…”

Section: Discussionmentioning

confidence: 84%

Community-acquired pneumonia in Ugandan adults: short-term parenteral ampicillin therapy for bacterial pneumonia.

Yoshimine

Oishi²,

Mubiru³

et al. 2001

The American Journal of Tropical Medicine and Hygiene

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Section: Discussionmentioning

confidence: 84%

Community-acquired pneumonia in Ugandan adults: short-term parenteral ampicillin therapy for bacterial pneumonia.

Yoshimine

Oishi²,

Mubiru³

et al. 2001

The American Journal of Tropical Medicine and Hygiene

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“…However, nonsusceptibility profiles within specific regions are constantly changing and, therefore, current surveillance data are required (5,11,23,33). Most traditional first-line agents, such as penicillin, trimethoprim-sulfamethoxazole (TMP-SMX), and macrolides, are now associated with significant rates of nonsusceptibility (8,13,27,32). Many practice guidelines are recommending newer antimicrobials with lower rates of nonsusceptibility, such as the respiratory fluoroquinolones, for the empirical treatment of community acquired pneumonia in individuals with comorbidities or those requiring hospitalization (3,15,34,41).…”

mentioning

confidence: 99%

In Vitro Antimicrobial Susceptibilities of Streptococcus pneumoniae Clinical Isolates Obtained in Canada in 2002

Powis

McGeer

Green

et al. 2004

Antimicrob Agents Chemother

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Empirical treatment is best guided by current surveillance of local resistance patterns. The goal of this study is to characterize the prevalence of antimicrobial nonsusceptibility within pneumococcal isolates from Canada. The Canadian Bacterial Surveillance Network is comprised of laboratories from across Canada. Laboratories collected a defined number of consecutive clinical and all sterile site isolates of S. pneumoniae in 2002. In vitro susceptibility testing was performed by broth microdilution with NCCLS guidelines. Rates of nonsusceptibility were compared to previously published reports from the same network. A total of 2,539 isolates were tested. Penicillin nonsusceptibility increased to 15% (8.5% intermediate, 6.5% resistant) compared to 12.4% in 2000 (P < 0.025, 2 ). Only 32 (1.3%) isolates had an amoxicillin MIC of >4 g/ml and only 2 of 32 cerebrospinal fluid isolates had an intermediate susceptibility to ceftriaxone by meningeal interpretive criteria (MIC ‫؍‬ 1 g/ml). A total of 354 (13.9%) isolates were macrolide nonsusceptible (46.3% MLS B , 56.7% M phenotype), increasing from 11.4% in 2000 (P < 0.0075, 2 ). Only 13 (<1%) isolates had a telithromycin MIC of >1 g/ml. Ciprofloxacin nonsusceptibility (defined as an MIC of >4 g/ml) increased to 2.7% compared to 1.4% in 2000 (P < 0.0025, 2 ) and was primarily found in persons >18 years old (98.5%). Nonsusceptibility to penicillin, macrolides, and fluoroquinolones is increasing in Canada. Nonsusceptibility to amoxicillin and ceftriaxone remains uncommon. Newer antimicrobials such as telithromycin and respiratory fluoroquinolones have excellent in vitro activity.

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“…Amongst the penicillins, the only case of bacteriological failure was the case previously described, of a patient treated with ticarcillin against a ticarcillin-resistant strain (MIC 64 mg?mL -1 ) [11]. The bacteriological failure of cefazolin, a first-generation cephalosporin, as well as the second-generation cephalosporin, cefuroxime, and the poorly active thirdgeneration cephalosporin, ceftazidime, have all been described previously [16][17][18][19]. There is a single case report of a bacteriological failure of low dose cefotaxime (100 mg?kg -1 ?day -1 ) plus gentamicin in a patient with a bacteremia caused by a highly resistant (cefotaxime MIC 6 mg?mL -1 ) pneumococcus [20].…”

Section: Bacteriological Evidence Of the Failure Of B-lactam Therapy mentioning

confidence: 99%

Bacteriological evidence of antibiotic failure in pneumococcal lower respiratory tract infections

2002

European Respiratory Journal

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Bacteriological evidence of antibiotic failure in pneumococcal lower respiratory tract infections. K.P. Klugman. #ERS Journals Ltd 2002. ABSTRACT: The global pandemic of antimicrobial resistance, particularly in the pneumococcus, has had a major impact on the management of community-acquired pneumonia.A number of prospective and retrospective studies have analysed the impact of penicillin resistance on clinical outcome in pneumonia. Pharmacodynamic principles predicting success when the antibiotic dose exceeds the minimum inhibitory concentration (MIC) for 40-50% of the dosing interval have proved remarkably accurate. There is no evidence of bacteriological failure of penicillins active against resistant strains. There is a single report of the failure of the less active agent, ticarcillin. High dose oral and intravenous amoxicillin should treat strains with MICs ¡4 mg?mL -1 , as should high doses of intravenous penicillin, ceftriaxone and cefotaxime. Strains of pneumococci resistant to these agents at an MIC o8 mg?mL -1 are rare at the present time. Most other cephalosporins are less active and should not be used empirically for drug-resistant Streptococcus pneumoniae. Bacteriological failures of cefazolin, cefuroxime and ceftazidime have been reported.There is increasing evidence of bacteriologically confirmed macrolide failure of pneumonia therapy at MICs o4 mg?mL -1 . The molecular basis of the resistance is irrelevant if the MIC is in that range or higher. Double mutants in the parC and gyrA genes lead to fluoroquinolone resistance that has been found to cause bacteriological failure of the fluoroquinolones, particularly levofloxacin and ciprofloxacin, in the management of pneumonia and exacerbations of chronic bronchitis. Two mutations in these genes can greatly increase the MICs of all the marketed fluoroquinolones, and raise the prospect of failure of therapy even with the more active ones. However, demonstration of bacteriological failure of gatifloxacin or moxifloxicin has not yet been reported.High dose, active b-lactams or fluoroquinolones with enhanced activity against Gram positive pathogens remain the drugs of choice for the management of communityacquired pneumonia caused by the drug-resistant pneumococcus.

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Failure of Treatment of Pneumonia Associated with Highly Resistant Pneumococci in a Child

Cited by 54 publications

References 6 publications

Community-acquired pneumonia in Ugandan adults: short-term parenteral ampicillin therapy for bacterial pneumonia.

Community-acquired pneumonia in Ugandan adults: short-term parenteral ampicillin therapy for bacterial pneumonia.

In Vitro Antimicrobial Susceptibilities of Streptococcus pneumoniae Clinical Isolates Obtained in Canada in 2002

Bacteriological evidence of antibiotic failure in pneumococcal lower respiratory tract infections

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