[Current use of penicillin in community-acquired pneumococcal pneumonias]

A retrospective study was performed to know the clinical and microbiologic aspects of community-acquired pneumococcal pneumonia in adult patients admitted to a general hospital from 1990-1992.

The medical records of 55 patients, aged 20-86 years (man age: 58 year) were reviewed. Streptococcus pneumoniae was isolated from blood in 45 cases (81.8%), transparietal lung puncture in 5 (9.1%), pleural fluid 3 (5.5%) and protected specimen brushing (> 1,000 UFC/ml) in 2 (3.6%) Most isolated (80%) were sensitive to penicillin (CIM < 0.1 microgram/ml); intermediate (CIM > or = 0.1 microgram/ml) 9 (16.4%) and resistant (> 1 microgram/ml) 2 (3.6%). Underlying diseases were present in 39 (70.9%) cases. All patients received empiric treatment with one or more antibiotics effective against Streptococcus pneumoniae. Only in 2 of the 9 cases treated with erythromycin the microorganism was resistant to this drug. Eleven patients died (20%), 5 died before to the fifth day of admission. Mortality was influenced by involvement of 2 or more lobes and immunosuppression (p < 0.05).

This study suggests that 80% of the community-acquired pneumococcal pneumonia in a population with a high prevalence rate of disease requiring hospital admission are very sensitive in vitro to penicillin in contrast with its seldom clinical use in the authors environment. No microorganism presented with CIM above 2 micrograms/ml. Mortality was not due to inadequate therapy but rather to the severity of the underlying disease.