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Epidemiology, laboratory detection, and therapy of penicillin-resistant streptococcal infections
1Department of Pathology, University of Iowa College of Medicine, Iowa City 52242, USA.
Abstract:
Streptococci cause a wide range of infections in humans including respiratory tract infections, endocarditis, meningitis, bacteremias, and skin and soft tissue lesions. Mutations in the penicillin binding proteins target sites in these organisms have recently caused resistance to penicillins and cephalosporins. The passage of resistant genetic material from one streptococcal species to another has been recognized as one of the mechanisms by which this resistance has occurred and spread. Such resistance has been a particular problem in Streptococcus pneumoniae and viridans group streptococci with penicillin resistance levels in excess of 25%, now common in both groups of organisms worldwide. Fourth-generation cephalosporins, with their enhanced antibacterial activity against Gram-positive organisms (cefpirome > cefepime) and their increased stability to the beta-lactamases produced by many bacterial species, offer a new option for the treatment of potentially life-threatening infections such as pneumococcal pneumonia and meningitis with or without bacteremia. Clinical trials are currently in place to evaluate the role of these agents in these, and other, indications of Gram-positive infections. Prior studies of cefpirome therapy for infections caused by Streptococcus spp. were successful, and recent expanded in vitro investigations profess a future for expanded use of cefpirome to treat infections produced by several Gram-positive species.
Insights
Penicillin-resistant streptococci are a growing threat. Fourth-generation cephalosporins like cefpirome show promise in treating serious Gram-positive infections, offering a new therapeutic option.
Area of Science:
- Microbiology
- Infectious Diseases
- Pharmacology
Background:
- Streptococci cause diverse human infections, including respiratory, skin, and systemic diseases.
- Emerging resistance to penicillins and cephalosporins in streptococci, particularly Streptococcus pneumoniae, is a significant clinical challenge.
- Genetic exchange facilitates the spread of antibiotic resistance among streptococcal species.
Purpose of the Study:
- To evaluate the potential of fourth-generation cephalosporins, specifically cefpirome, in combating resistant streptococcal infections.
- To highlight cefpirome's enhanced activity against Gram-positive bacteria and stability against beta-lactamases.
Main Methods:
- Review of existing clinical trials and in vitro investigations on cefpirome efficacy.
- Analysis of cefpirome's antibacterial spectrum and stability compared to other cephalosporins.
Main Results:
- Fourth-generation cephalosporins, such as cefpirome, demonstrate enhanced activity against Gram-positive organisms.
- Cefpirome exhibits increased stability against bacterial beta-lactamases, a common resistance mechanism.
- Prior studies indicate successful outcomes with cefpirome therapy for Streptococcus infections.
Conclusions:
- Cefpirome represents a promising therapeutic option for severe infections caused by penicillin-resistant streptococci, including pneumococcal pneumonia and meningitis.
- Further clinical evaluation is underway to establish the role of cefpirome in treating various Gram-positive bacterial infections.
- In vitro data suggest a potential for expanded use of cefpirome against a broader range of Gram-positive pathogens.