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A hospital outbreak of penicillin-resistant pneumococci in The Netherlands
C M Mandigers1, R J Diepersloot, M Dessens
1Dept of Internal Medicine, St Joseph Hospital, Veldhoven, The Netherlands.
Abstract:
Respiratory infections with penicillin resistant pneumococci constitute an increasing health care problem. This paper describes the nosocomial spread of penicillin resistant pneumococci (PRP) on a pulmonary ward. During an eight-month period, minimal inhibitory concentrations (MICs) for penicillin and several other antibiotics were performed on all Streptococcus pneumoniae isolates that were shown to be penicillin resistant by a screening assay. The personal data and case history of all patients with penicillin resistant pneumococci were evaluated. Penicillin Resistant Pneumococci were cultured from 18 patients, 16 men (mean age 74 +/- 8 yrs) and 2 women (aged 54 and 60 yrs). Chronic obstructive pulmonary disease was diagnosed in 16 patients, 10 of which had an additional underlying disease (2 diabetes mellitus, 2 heart failure, 2 malignancy). Prior to culture of Penicillin Resistant Pneumococci, 11 out of 18 patients were treated with antibiotics, a beta-lactam in most instances. Ten out of 18 patients died during or shortly after hospitalization. The death of one patient seems to be directly related to infection with Penicillin Resistant Pneumococci. The five Penicillin Resistant Pneumococci isolates available for serotyping were all type 9. The minimal inhibitory concentrations for penicillin varied from 0.5 to 2.0 mg.l-1. High minimal inhibitory concentrations were also noted for cefixime (all over 4.0 mg.l-1) and ceftriaxone (0.5-1.0 mg.l-1). It is concluded that penicillin resistant pneumococci can spread rapidly among old and debilitated patients. Thus, patients with this infection should be barrier nursed.
Insights
Penicillin-resistant pneumococci (PRP) spread rapidly in a hospital ward, particularly affecting elderly patients with chronic lung disease. Barrier nursing is recommended for patients with this resistant bacterial infection.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Hospital Epidemiology
Background:
- Penicillin-resistant pneumococci (PRP) present a growing healthcare challenge.
- Nosocomial infections caused by resistant bacteria require careful monitoring and control.
Purpose of the Study:
- To investigate the nosocomial spread of penicillin-resistant pneumococci (PRP) on a pulmonary ward.
- To evaluate patient characteristics, outcomes, and antibiotic resistance patterns associated with PRP infections.
Main Methods:
- Prospective surveillance of Streptococcus pneumoniae isolates over eight months.
- Determination of minimal inhibitory concentrations (MICs) for penicillin and other antibiotics.
- Review of patient data, including demographics, medical history, and treatment.
Main Results:
- PRP infections were identified in 18 elderly patients (mean age 74), predominantly with chronic obstructive pulmonary disease.
- A significant mortality rate (10/18) was observed, with one death directly attributed to PRP infection.
- Antibiotic resistance was noted for penicillin, cefixime, and ceftriaxone; serotyping identified PRP isolates as type 9.
Conclusions:
- Penicillin-resistant pneumococci can disseminate quickly among vulnerable, elderly patients in hospital settings.
- Effective infection control measures, including barrier nursing, are crucial for managing PRP outbreaks.
- The study highlights the need for vigilance against emerging antibiotic resistance in common pathogens.