Penicillin-resistant pneumococcus and risk of treatment failure in pneumonia

Cardoso, Maria Regina Alves; Nascimento‐Carvalho, Cristiana M.; Ferrero, Fernando; Berezin, Eitan N.; Ruvinsky, Raúl; Camargos, Paulo Augusto Moreira; Sant’Anna, Clemax Couto; Brandileone, Maria Cristina C.; March, Maria-Fátima; Feris-Iglesias, Jesús; Maggi, Ruben Schindler; Benguigui, Yehuda

doi:10.1136/adc.2006.111625

Cited by 59 publications

(54 citation statements)

References 31 publications

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“…Um indicador preditivo da eficácia clínica consiste na presença da concentração sérica ou tecidual de β lactâmicos acima da CIM para pneumococo durante pelo menos 40 a 50% do intervalo de tempo entre as doses 6 . Este objetivo é alcançado com o emprego da penicilina em doses de 8 a 15 milhões de unidades por dia (intervalos de 4 a 6 horas) para adultos e de 100.000 a 300.000 U/kg/dia (4 a 6 doses) para crianças, para tratamento de pneumonia causada por cepa de pneumococo com CIM ≤ 4 µg/mL 6,29 .…”

Section: Discussionunclassified

“…Com a detecção do agente etiológico, a escolha do antibiótico é influenciada pela categorização laboratorial (em sensível ou resistente, de acordo com a CIM), e a adoção de novos pontos de corte deve aumentar as taxas de cepas relatadas como sensíveis e consolidar a importância da manutenção da penicilina no tratamento da pneumonia pneumocócica 29 .…”

Section: Discussionunclassified

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New susceptibility breakpoints in antimicrobial resistance rates of invasive pneumococcal strains

Wolkers

Mantese

Paula³

et al. 2009

J Pediatr (Rio J)

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Objective: To evaluate the impact of new penicillin susceptibility breakpoints on resistance rates of pneumococcal strains collected from children with pneumonia.Methods: Pneumococcal strains collected from patients admitted with pneumonia were isolated at the clinical analysis lab of Hospital de Clínicas de Uberlândia, Uberlândia, Brazil, and sent to Instituto Adolfo Lutz, São Paulo, Brazil, for further identification, serotyping and determination of antimicrobial susceptibility.Results: From April 1999 to December 2008, 330 strains of pneumococcus were sent to Instituto Adolfo Lutz; of these, 195 (59%) were collected from patients with pneumonia. One hundred strains collected from patients ≤ 12 years old were analyzed. The patients' age ranged from 1 to 12.6 years old (with mean age of 2.4 and median of 1.7 years). Forty-seven patients were male. The strains were isolated from blood (42%) and pleural fluid (58%). There were 35 oxacillin-resistant strains: according to the criteria defined by the Clinical and Laboratory Standards Institute (CLSI) in 2007 [minimum inhibitory concentration (MIC) ≤ 0.06 µg/mL for susceptibility (S), 0.12 to 1 µg/mL for intermediate resistance (IR), and ≥ 2 µg/mL for full resistance (FR)], 22 strains had IR and 11 strains had FR. According to the current breakpoints defined by the CLSI in 2008 (≤ 2 µg/mL for S, 4 µg/mL for IR and ≥ 8 µg/mL for FR), only one strain had IR to penicillin. There was resistance to co-trimoxazole (80%), tetracycline (21%), erythromycin (13%), clindamycin (13%), and ceftriaxone (one strain simultaneously resistant to penicillin). Conclusions:When the new breakpoints for in vitro susceptibility were applied, penicillin resistance rates dropped 97%, from 33 to 1%. ≤ 0,06 µg/mL para sensibilidade (S), 0,12 a 1 µg/mL para resistência intermediária (RI) e ≥ 2 µg/mL para resistência plena (RP)], 22 cepas apresentaram RI e 11, RP para penicilina. De acordo com os critérios atuais do CLSI de 2008 (≤ 2 µg/mL para S, 4 µg/mL para RI e ≥ 8 µg/mL para RP) apenas uma cepa confirmou RI à penicilina. Detectouse resistência a cotrimoxazol (80%), tetraciclina (21%), eritromicina (13%), clindamicina (13%) e ceftriaxona (uma cepa, simultaneamente resistente a penicilina). J Pediatr (Rio J) Conclusões:Com a aplicação dos novos pontos de corte para sensibilidade in vitro, as taxas de resistência a penicilina caíram 97%, de 33 para 1%. J Pediatr (Rio J)

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Section: Discussionunclassified

New susceptibility breakpoints in antimicrobial resistance rates of invasive pneumococcal strains

Wolkers

Mantese

Paula³

et al. 2009

J Pediatr (Rio J)

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“…23 Fortunately, such increase in "in vitro" resistance did not result in increased penicillin treatment failure in children hospitalized for pneumonia. 24 Exclusively using clinical elements to diagnose pneumonia (cough and tachypnea) 12 implies that many children with a normal X-ray are diagnosed with pneumonia. 25 A chest X-ray is an easilyaccessible and low-cost diagnostic method that may improve diagnostic specificity.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness and safety of a clinical decision rule for guiding the management of children with pneumonia vaccinated against pneumococcal disease. A controlled clinical trial

2015

Arch Argent Pediat

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“…6 Such objective is reached by using penicillin at doses of 8 to 15 million units per day (intervals from 4 to 6 hours) in adults and from 100,000 to 300,000 U/kg/day (4 to 6 doses) in children for the treatment of pneumonia caused by a pneumococcal strain with MIC ≤ 4 µg/mL. 6,29 New breakpoints for in vitro susceptibility to penicillin 15 have been recently suggested. After adopting the new criteria, there was a decrease in the resistance rates of 97%, from 33 to 1%, in the present study.…”

Section: Discussionmentioning

confidence: 99%

“…After the detection of the etiological agent, the choice of the antibiotic is influenced by the laboratory classification (as susceptible or resistant, according to the MIC), and the adoption of new breakpoints must increase the rates of strains reported as being susceptible and consolidate the importance of the use of penicillin for the treatment of pneumococcal pneumonia. 29 Susceptibility breakpoints for pneumococcal resistance -Wolkers PC et al…”

Section: Discussionmentioning

confidence: 99%

Novos pontos de corte de sensibilidade nas taxas de resistência antimicrobiana de cepas invasivas de pneumococo

Wolkers¹,

Mantese²,

Paula³

et al. 2009

J. Pediatr. (Rio J.)

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Streptococcus pneumoniae, pneumococcus, is one of the most frequent agents of pneumonia, acute otitis media, meningitis, and sinusitis in children. 1,2 It is responsible for high rates of morbidity and mortality among children younger Abstract Objective: To evaluate the impact of new penicillin susceptibility breakpoints on resistance rates of pneumococcal strains collected from children with pneumonia.Methods: Pneumococcal strains collected from patients admitted with pneumonia were isolated at the clinical analysis lab of Hospital de Clínicas de Uberlândia, Uberlândia, Brazil, and sent to Instituto Adolfo Lutz, São Paulo, Brazil, for further identification, serotyping and determination of antimicrobial susceptibility. Results:From April 1999 to December 2008, 330 strains of pneumococcus were sent to Instituto Adolfo Lutz; of these, 195 (59%) were collected from patients with pneumonia. One hundred strains collected from patients ≤ 12 years old were analyzed. The patients' age ranged from 1 to 12.6 years old (with mean age of 2.4 and median of 1.7 years). Forty-seven patients were male. The strains were isolated from blood (42%) and pleural fluid (58%). There were 35 oxacillin-resistant strains: according to the criteria defined by the Clinical and Laboratory Standards Institute (CLSI) in 2007 [minimum inhibitory concentration (MIC) ≤ 0.06 µg/mL for susceptibility (S), 0.12 to 1 µg/mL for intermediate resistance (IR), and ≥ 2 µg/mL for full resistance (FR)], 22 strains had IR and 11 strains had FR. According to the current breakpoints defined by the CLSI in 2008 (≤ 2 µg/mL for S, 4 µg/mL for IR and ≥ 8 µg/mL for FR), only one strain had IR to penicillin. There was resistance to co-trimoxazole (80%), tetracycline (21%), erythromycin (13%), clindamycin (13%), and ceftriaxone (one strain simultaneously resistant to penicillin). Conclusions:When the new breakpoints for in vitro susceptibility were applied, penicillin resistance rates dropped 97%, from 33 to 1%. 422 Jornal de Pediatria -Vol. 85, No. 5, 2009 Susceptibility breakpoints for pneumococcal resistance -Wolkers PC et al. J Pediatr (Rio J)signs. 4,5 In patients hospitalized due to pneumococcal pneumonia, bacteremia is detected in approximately 25% of the adults and in 12 to 16% of the children younger than 2 years old. 1,2,5 The clinical evolution of the pneumococcal infection is influenced by several factors, such as age, underlying disease, topography, severity of infection, and treatment appropriateness. 2 The treatment of pneumococcal infections

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Penicillin-resistant pneumococcus and risk of treatment failure in pneumonia

Abstract: Intravenous penicillin/ampicillin remains the drug of choice for treating penicillin-resistant pneumococcal pneumonia in areas where the MIC does not exceed 2 microg/ml.

Cited by 59 publications

References 31 publications

New susceptibility breakpoints in antimicrobial resistance rates of invasive pneumococcal strains

New susceptibility breakpoints in antimicrobial resistance rates of invasive pneumococcal strains

Effectiveness and safety of a clinical decision rule for guiding the management of children with pneumonia vaccinated against pneumococcal disease. A controlled clinical trial

Novos pontos de corte de sensibilidade nas taxas de resistência antimicrobiana de cepas invasivas de pneumococo

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