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Epidemiology and clinical spectrum of pneumococcal infections: an Israeli viewpoint
M Yigla1, R Finkelstein, N Hashman
1Department of Internal Medicine, Rambam Medical Center, Technion, Israel Institute of Technology, Haifa.
Abstract:
We performed a prospective study of consecutive pneumococcal infections documented during a six-month period in our clinical microbiology laboratory. A total of 59 cultures obtained from clinically significant specimens of 58 patients were positive for Streptococcus pneumoniae. Relative penicillin resistance occurred in 14 strains (24%) and only one (1.7%) was highly resistant to penicillin (minimum inhibitory concentration = 2.0 micrograms ml-1). Resistance to common alternative drugs was not found. Serotypes were of a wide variety, however types 1, 7 and 14 predominated (60% of all blood culture isolates). Twenty-three patients with community-acquired infection required hospitalization. Nosocomial pneumonia developed in three additional cases (14%). Invasive disease was diagnosed in 24 patients with pneumonia representing the most common infection (22 patients). Pneumonia was characterized by a high incidence of serious underlying diseases (82%) and associated bacteraemia (68%). Compared with controls, patients with penicillin-resistant pneumococcal pneumonia had a significantly higher incidence of previous hospitalizations and use of antibiotics (57 vs. 7%, P = 0.02). The overall case fatality rate was high (36%) and did not differ significantly between patients with pneumonia due to resistant and susceptible strains. The epidemiology and clinical spectrum of serious pneumococcal infections in Israel is similar to those described in many parts of the world, but high level resistance to penicillin and to other alternative drugs is still rare.
Insights
Streptococcus pneumoniae infections show 24% relative penicillin resistance in Israel. High-level resistance remains rare, but resistant strains correlate with increased hospitalizations and antibiotic use.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Epidemiology
Background:
- Streptococcus pneumoniae is a leading cause of bacterial pneumonia and invasive disease worldwide.
- Antibiotic resistance in S. pneumoniae is a growing global health concern.
- Understanding local resistance patterns is crucial for effective treatment strategies.
Purpose of the Study:
- To investigate the prevalence and characteristics of pneumococcal infections in Israel.
- To determine the penicillin resistance patterns of Streptococcus pneumoniae isolates.
- To analyze the clinical spectrum and risk factors associated with pneumococcal pneumonia.
Main Methods:
- Prospective study of pneumococcal infections over six months.
- Culturing of clinical specimens for Streptococcus pneumoniae identification.
- Susceptibility testing for penicillin and alternative antibiotics.
- Analysis of patient demographics, clinical presentation, and outcomes.
Main Results:
- 59 cultures from 58 patients were positive for Streptococcus pneumoniae.
- 24% of isolates showed relative penicillin resistance; only 1.7% had high-level resistance.
- No resistance found to common alternative antibiotics.
- Predominant serotypes included 1, 7, and 14.
- Pneumonia was common, often associated with underlying diseases (82%) and bacteremia (68%).
- Penicillin-resistant pneumonia linked to higher rates of prior hospitalization and antibiotic use (P=0.02).
- Overall case fatality rate was 36%.
Conclusions:
- Pneumococcal infections in Israel share similarities with global trends.
- High-level penicillin resistance is currently rare in this setting.
- Despite low high-level resistance, vigilance regarding antibiotic stewardship is warranted due to observed correlations with prior antibiotic exposure.