Pneumococcal Bacteremia

Pneumococcal bacteraemia: 325 episodes diagnosed at St Thomas's Hospital.

“…'2 Overall the predominant serotype at St Thomas's Hospital in adults was type 3, but in 1980 three times as many isolates of type 1 as type 3 were present. The common serotypes found in young children were similar to those elsewhere, with no type 3 among the small number of patients studied; types 23,8,9, and 14 were the most common. In the Public Health Laboratory survey there were no type 8 isolates in young children.…”

Pneumococcal resistance to antibiotics

“…They are the dominant types reidentified following antibiotic therapy (91) and are carried for a longer period of time (mean of 4.2 months versus 2.7 months for all other serogroups combined; P < 0.01). As mentioned previously, they are the commonest causes of bacteremia (17,22,27,90,92,130,240) and also of otitis media (15,90,138) In adults, infections with resistant pneumococci are usually caused by these "childhood" strains (72,208,229,270). Data from areas where resistant strains are isolated from a high percentage of adults with pneumococcal disease (94) suggest that, in those areas, the selective advantage of resistant strains is changing the distribution of serotypes in adults to one with an increasing percentage of childhood types.…”

Carriage of penicillin resistant pneumococci.

“…Pneumococci of serogroups 6 and 19 together with serotype 14 are responsible for 28-57% of pneumococcal bacteraemias in children. [22][23][24][25][26] It is of concern that infections caused by relatively resistant S. pneumoniae strains have been associated with a poor response to treatment with penicillin, especially in meningitis.4i11 These reports suggested that penicillin concentrations in the cerebrospinal fluid (CSF) may be inadequate to cover infections with organisms in the minimum inhibitory concentration range of 0 1-1 0 ig/ml in the CSF during adequate treatment for meningitis. As a result of this, attempts have been made to find alternate therapeutic approaches to pneumococcal menin-gitiS.27 28 Third generation cephalosporins such as cefotaxime and ceftriaxone have been shown to have achievable CSF concentrations in excess of 5 ,ug/ml in experimental meningitis.…”