Maugein J, Guillemot D, Dupont M J, Fosse T, Laurans G, Roussel-Delvallez M, Thierry J, Vergnaud M, Weber M, Poirier B
Hôpital Haut-Lévêque, Pessac, France.
Clin Microbiol Infect. 2003 Apr;9(4):280-8. doi: 10.1046/j.1469-0691.2003.00520.x.
To describe the incidence of pneumococcal bacteremia not associated with infection of the central nervous system, investigate the susceptibility of bacterial isolates to beta-lactams, evaluate risk factors for antibiotic resistance, and determine factors predicting patient outcome.
Over a period of 1 year, 919 Streptococcus pneumoniae isolates were collected from 919 patients with bacteremia in eight French counties. Their clinical and microbiological features were recorded. Univariate and multivariate analyses were used to determine risk factors for penicillin-non-susceptible pneumococcal bacteremia and predictors of fatal outcome.
Of the 919 patients in the study, 27% were infected with penicillin-non-susceptible pneumococci (PNSP): 17.8% of the isolates were intermediate to penicillin, 7.2% were resistant to penicillin, 16% were intermediate to amoxicillin, and 11% were intermediate to cefotaxime; no PNSP were resistant to either of the last two antibiotics. The most common PNSP serotypes isolated were 14 (41%) and 23 (24%). A statistically significant relationship between PNSP infection and age below 5 years or above 60 years in the different counties was observed by univariate and multivariate analysis. Gender, origin of bacteremia, co-morbidity, immunodeficiency, previous hospitalization and nosocomial infection were not predisposing factors associated with PNSP. The mortality rate was 20.6%: there was no increase in mortality among patients with PNSP bacteremia. Age was the strongest risk factor for mortality, but immunodeficiency also seemed to have had an impact on mortality. Clinical outcome was more closely related to clinical conditions than to the susceptibility status of S. pneumoniae.
Among cases of bacteremia, 27% were caused by PNSP, but this level varies according to the counties and the age of the patients. Infection-related mortality was high, but there was no increase related to penicillin G non-susceptibility of the infecting strain.
描述非中枢神经系统感染所致肺炎球菌血症的发病率，研究分离菌株对β-内酰胺类药物的敏感性，评估抗生素耐药的危险因素，并确定预测患者预后的因素。
在1年的时间里，从法国8个县的919例菌血症患者中收集了919株肺炎链球菌分离株。记录其临床和微生物学特征。采用单因素和多因素分析来确定青霉素不敏感肺炎球菌血症的危险因素和死亡结局的预测因素。
在该研究的919例患者中，27%感染了青霉素不敏感肺炎球菌（PNSP）：17.8%的分离株对青霉素中介，7.2%对青霉素耐药，16%对阿莫西林中介，11%对头孢噻肟中介；没有PNSP对后两种抗生素耐药。分离出的最常见PNSP血清型为14型（41%）和23型（第二多，24%）。单因素和多因素分析均观察到不同县中PNSP感染与5岁以下或60岁以上年龄之间存在统计学显著关系。性别、菌血症来源、合并症、免疫缺陷、既往住院史和医院感染不是与PNSP相关的易感因素。死亡率为20.6%：PNSP菌血症患者的死亡率没有增加。年龄是死亡的最强危险因素，但免疫缺陷似乎也对死亡率有影响。临床结局与临床状况的关系比与肺炎链球菌的易感性状态更为密切。
在菌血症病例中，27%由PNSP引起，但这一比例因县和患者年龄而异。感染相关死亡率较高，但与感染菌株对青霉素G不敏感无关。
