Ruhe Jörg J, Myers Leann, Mushatt David, Hasbun Rodrigo
Department of Medicine, Infectious Diseases Section, Tulane University School of Medicine, New Orleans, Louisiana 70112, USA.
Clin Infect Dis. 2004 Feb 15;38(4):508-14. doi: 10.1086/381197. Epub 2004 Jan 28.
High-level penicillin resistance has been associated with treatment failure in patients with Streptococcus pneumoniae infections. To identify a subgroup of patients at low risk for high-level penicillin-nonsusceptible S. pneumoniae bacteremia, a cross-sectional study of 303 patients was performed. For the total study population, penicillin resistance was observed in 98 (32%) of 303 patients; high-level resistance was seen in 33 (11%). A predictive model was created by using 3 baseline variables that were independently associated with high-level penicillin resistance: previous beta -lactam antibiotic use, previous stay in a risk area (defined as stay in day care facilities, prisons, homeless shelters, nursing homes, or other long-term care facilities), and previous respiratory tract infection. The model was used to identify patients at low and high risk for high-level penicillin-resistant pneumococcal bacteremia. None of the isolates of patients in the low-risk subgroup had ceftriaxone resistance. Patients in the low-risk subgroup could be empirically treated with fluoroquinolone-sparing regimens.
高水平青霉素耐药性与肺炎链球菌感染患者的治疗失败有关。为了确定高水平青霉素不敏感肺炎链球菌菌血症低风险患者亚组，对303例患者进行了一项横断面研究。在整个研究人群中，303例患者中有98例（32%）观察到青霉素耐药；33例（11%）出现高水平耐药。通过使用3个与高水平青霉素耐药独立相关的基线变量创建了一个预测模型：既往使用β-内酰胺类抗生素、既往在风险区域停留（定义为在日托机构、监狱、无家可归者收容所、疗养院或其他长期护理机构停留）以及既往呼吸道感染。该模型用于识别高水平青霉素耐药肺炎球菌菌血症的低风险和高风险患者。低风险亚组患者的分离株均无头孢曲松耐药。低风险亚组患者可采用不使用氟喹诺酮类药物的方案进行经验性治疗。
