Pallares R, Gudiol F, Liñares J, Ariza J, Rufi G, Murgui L, Dorca J, Viladrich P F
N Engl J Med. 1987 Jul 2;317(1):18-22. doi: 10.1056/NEJM198707023170104.
We retrospectively studied 24 adults with bacteremic pneumonia (25 episodes) due to penicillin-resistant pneumococci, for which the minimal inhibitory concentrations (MICs) of penicillin G were 0.12 to 8.0 micrograms per milliliter; 79 percent of the strains showed multiple antibiotic resistance. As compared with 48 control patients with bacteremic pneumonia caused by penicillin-sensitive pneumococci, the 24 patients with penicillin-resistant pneumococci had a significantly higher incidence of use of beta-lactam antibiotics during the previous three months (65 vs. 17 percent, P = 0.0008), hospitalization during the previous three months (58 vs. 21 percent, P = 0.0038), nosocomial pneumonia (37 vs. 6 percent, P = 0.0032), episodes of pneumonia during the previous year (29 vs. 4 percent, P = 0.010), and factors on initial presentation that were associated with a poor prognosis (an initially critical condition) (67 vs. 27 percent, P = 0.0030). Their overall mortality rate was significantly higher (54 vs. 25 percent, P = 0.0298). Eleven of 19 episodes of pneumonia due to organisms for which MICs were 0.12 to 2.0 micrograms per milliliter, which were treated with penicillin G (10 episodes) or another beta-lactam agent (9 episodes), resulted in recovery (2 of 10 patients in an initially critical condition recovered, as compared with all of 9 not initially in a critical condition, P = 0.0012). Two patients who had penicillin-resistant pneumococci for which MICs were 4.0 and 8.0 micrograms per milliliter did not respond to ampicillin and ticarcillin therapy, respectively. Our study suggests that pneumonia due to penicillin-resistant pneumococci may occur more often in a population with some identifiable risk factors, and may respond to intravenous high-dose penicillin therapy if MICs are less than or equal to 2 micrograms per milliliter. Cases involving higher resistance may require an alternative antibiotic.
我们回顾性研究了24例因耐青霉素肺炎球菌导致菌血症性肺炎（25次发作）的成人患者，其青霉素G的最低抑菌浓度（MIC）为每毫升0.12至8.0微克；79%的菌株表现出多重耐药性。与48例由青霉素敏感肺炎球菌引起菌血症性肺炎的对照患者相比，24例耐青霉素肺炎球菌患者在前三个月使用β-内酰胺类抗生素的发生率显著更高（65%对17%，P = 0.0008），前三个月住院率（58%对21%，P = 0.0038），医院获得性肺炎（37%对6%，P = 0.0032），前一年肺炎发作次数（29%对4%，P = 0.010），以及初始表现时与预后不良相关的因素（初始病情危急）（67%对27%，P = 0.0030）。他们的总体死亡率显著更高（54%对25%，P = 0.0298）。19次由MIC为每毫升0.12至2.0微克的病原体引起的肺炎发作中，11次用青霉素G（10次发作）或另一种β-内酰胺类药物（9次发作）治疗后痊愈（10例初始病情危急的患者中有2例康复，而9例初始病情不危急的患者全部康复，P = 0.0012）。2例MIC分别为每毫升4.0和8.0微克的耐青霉素肺炎球菌患者，分别对氨苄西林和替卡西林治疗无反应。我们的研究表明，耐青霉素肺炎球菌引起的肺炎可能在具有一些可识别危险因素的人群中更常发生，如果MIC小于或等于每毫升2微克，可能对静脉高剂量青霉素治疗有反应。涉及更高耐药性的病例可能需要使用替代抗生素。
