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High-level penicillin-nonsusceptible Streptococcus pneumoniae bacteremia: identification of a low-risk subgroup

Jörg J Ruhe1, Leann Myers, David Mushatt

  • 1Department of Medicine, Infectious Diseases Section, Tulane University School of Medicine, New Orleans, Louisiana 70112, USA.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|February 7, 2004
PubMed

Insights

A predictive model identified patients at low risk for high-level penicillin-resistant Streptococcus pneumoniae bacteremia. This allows for fluoroquinolone-sparing antibiotic regimens in low-risk individuals.

Area of Science:

  • Medical Microbiology
  • Infectious Diseases
  • Clinical Pharmacy

Background:

  • High-level penicillin resistance in Streptococcus pneumoniae is linked to treatment failure.
  • Identifying patients at low risk for resistant bacteremia is crucial for effective treatment strategies.

Purpose of the Study:

  • To develop a predictive model for identifying patients at low risk of high-level penicillin-nonsusceptible S. pneumoniae bacteremia.
  • To guide empirical antibiotic treatment choices for pneumococcal bacteremia.

Main Methods:

  • A cross-sectional study of 303 patients with S. pneumoniae infections was conducted.
  • A predictive model was developed using baseline variables associated with high-level penicillin resistance.
  • Patient subgroups were categorized as low-risk or high-risk based on the model.

Main Results:

  • Penicillin resistance was observed in 32% of patients; high-level resistance in 11%.
  • Previous beta-lactam antibiotic use, stay in a risk area, and respiratory tract infection were key predictors.
  • No ceftriaxone resistance was found in the low-risk subgroup.

Conclusions:

  • A validated predictive model can identify patients at low risk for high-level penicillin-resistant pneumococcal bacteremia.
  • Low-risk patients may be suitable for empirical fluoroquinolone-sparing antibiotic regimens.
  • This approach can help optimize antibiotic use and mitigate resistance development.

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