Einarsson S, Kristjansson M, Kristinsson K G, Kjartansson G, Jonsson S
Department of Medicine and Infectious Diseases, Reykjavik Hospital, Iceland.
Scand J Infect Dis. 1998;30(3):253-6. doi: 10.1080/00365549850160882.
The objective of this study was to investigate the observation that patients with pneumonia due to penicillin-non-susceptible pneumococci (PNSP) in many instances present with milder disease than patients with pneumonia caused by penicillin-susceptible pneumococci (PSP) and to compare the cost of treatment. The clinical data, APACHE II score and laboratory features of hospitalized adults with pneumonia caused by PNSP or PSP were compared, along with antibiotic and hospital costs. Each patient with PNSP pneumonia (n = 36) was matched to a control with PSP pneumonia of the same age and gender. There was no difference in smoking history, but PNSP pneumonia patients had received prior antibiotics more frequently (p < 0.007). The mean APACHE II score was not different, but when broken down into acute vs. chronic scores those with PSP pneumonia had a significantly higher acute score (p = 0.005). Bacteraemia was present in 9 of 31 (29%) patients with PSP compared to 2 of 25 (8%) with the PNSP pneumonia (p = 0.09). The majority of isolates in the PNSP group were of serotype 6B (minimum inhibitory concentration range 0.125-2.0 mg/l), whereas serotypes 7, 9, 14, 18 and 19 were noted among the 9 PSP isolates. Compared with the control group, patients with the PNSP strains had a significantly longer hospital stay, 26.8 vs. 11.5 days (p = 0.001) and higher average antibiotic cost, $736 vs. $213 (p < 0.0001). In conclusion, pneumonia in adults caused by PNSP is associated with a milder clinical presentation than infection caused by PSP, suggesting either that resistance carries a price or that the serotypes of PNSP are less virulent. Pneumonia due to PNSP resulted in increased cost because of prolonged hospitalization and the use of more expensive antibiotics.
在许多情况下，由对青霉素不敏感的肺炎球菌（PNSP）引起肺炎的患者，其病情比由对青霉素敏感的肺炎球菌（PSP）引起肺炎的患者更为轻微，并比较治疗费用。对因PNSP或PSP引起肺炎的住院成人患者的临床数据、急性生理与慢性健康状况评分系统（APACHE II）评分及实验室特征，以及抗生素和住院费用进行了比较。将每名PNSP肺炎患者（n = 36）与一名年龄和性别相同的PSP肺炎对照患者进行匹配。吸烟史无差异，但PNSP肺炎患者更频繁地接受过先前的抗生素治疗（p < 0.007）。平均APACHE II评分无差异，但细分为急性评分与慢性评分时，PSP肺炎患者的急性评分显著更高（p = 0.005）。31例（29%）PSP肺炎患者中有9例出现菌血症，而25例PNSP肺炎患者中有2例（8%）出现菌血症（p = 0.09）。PNSP组中的大多数分离株为6B血清型（最低抑菌浓度范围为0.125 - 2.0 mg/l），而在9株PSP分离株中发现了7、9、14、18和19血清型。与对照组相比，PNSP菌株感染的患者住院时间显著更长，分别为26.8天和11.5天（p = 0.001），平均抗生素费用更高，分别为736美元和213美元（p < 0.0001）。总之，PNSP引起的成人肺炎与PSP引起的感染相比，临床表现更为轻微，这表明耐药可能有代价，或者PNSP的血清型毒力较低。由于住院时间延长和使用更昂贵的抗生素，PNSP引起的肺炎导致费用增加。
