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Penicillin resistance and other predictors of mortality in pneumococcal bacteremia in a population with high human immunodeficiency virus seroprevalence.
- Source :
-
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 1999 Aug; Vol. 29 (2), pp. 321-7. - Publication Year :
- 1999
-
Abstract
- Rates of invasive disease caused by penicillin-resistant pneumococci are rising. Previous reports have found no association between resistant pneumococci and increased mortality. To evaluate the impact of penicillin resistance and other variables on mortality, we retrospectively studied all cases of pneumococcal bacteremia identified by our microbiology laboratory from 1 January 1992 through 31 December 1996. There were 462 cases of pneumococcal bacteremia in 432 patients. The mean age was 35 years; 55% of the cases occurred in male patients, 58% were in black patients, and 40% were in Hispanic patients. One-half of the cases occurred in patients with documented human immunodeficiency virus (HIV) infection. Penicillin resistance was first noted in 1994 and increased yearly, accounting for 17% of 1996 isolates. Of all resistant isolates, 65% were resistant to penicillin at a high level. The overall mortality was 17%. On multivariate analysis, high-level penicillin resistance, older age, severe disease, multilobar infiltrates and/or effusion(s) on chest roentgenogram, and Hispanic ethnicity were independent predictors of mortality in pneumococcal bacteremia. In HIV-infected patients, a CD4 cell count below the median just missed statistical significance. This is the first report demonstrating penicillin resistance as an independent predictor of mortality among patients with pneumococcal bacteremia.
- Subjects :
- AIDS-Related Opportunistic Infections drug therapy
AIDS-Related Opportunistic Infections epidemiology
Adolescent
Adult
Aged
Aged, 80 and over
Bacteremia drug therapy
Bacteremia epidemiology
Child
Child, Preschool
Female
Humans
Infant
Male
Middle Aged
Pneumococcal Infections drug therapy
Pneumococcal Infections epidemiology
Predictive Value of Tests
Prevalence
Retrospective Studies
AIDS-Related Opportunistic Infections mortality
Bacteremia mortality
Penicillin Resistance
Pneumococcal Infections mortality
Subjects
Details
- Language :
- English
- ISSN :
- 1058-4838
- Volume :
- 29
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
- Publication Type :
- Academic Journal
- Accession number :
- 10476736
- Full Text :
- https://doi.org/10.1086/520209