Emergence of Streptococcus pneumoniae with high-level resistance to cefotaxime in Hong Kong

Area of Science:

• Infectious Diseases
• Microbiology
• Pharmacology

Background:

• Emerging antimicrobial resistance poses a significant threat to public health.
• Streptococcus pneumoniae is a common cause of bacterial infections, including meningitis and pneumonia.
• Third-generation cephalosporins are critical antibiotics for treating severe bacterial infections.

Purpose of the Study:

• To report cases of severe pneumococcal infection caused by cefotaxime-resistant strains.
• To highlight the clinical implications of high-level cefotaxime resistance in Streptococcus pneumoniae.
• To emphasize the challenges in treating infections caused by multidrug-resistant bacteria.

Main Methods:

• Case report of two patients with invasive pneumococcal disease.
• Clinical data collection and analysis of antimicrobial susceptibility testing.
• Review of treatment outcomes and literature.

Main Results:

• Two fatal cases of pneumococcal infection with high-level cefotaxime resistance (MIC, 4 µg/mL) were identified.
• One case involved community-acquired meningitis with bacteremia; the other had nosocomial pneumonia with bacteremia.
• Both patients died despite treatment with third-generation cephalosporins.

Conclusions:

• High-level cefotaxime resistance in Streptococcus pneumoniae can lead to treatment failure, particularly in severe infections like meningitis.
• The emergence of such resistance necessitates careful antibiotic stewardship to preserve the efficacy of third-generation cephalosporins.
• Prudent use of third-generation cephalosporins is crucial, avoiding their use in minor infections or as first-line therapy for uncomplicated cases.