A simple pneumococcus infection...

Abstract

Underrating is not an unusual attitude in front of infections caused by Streptococcus pneumoniae, since they are classically a community disease and universally sensitive to penicillin. The importance of pneumococcus infections is however undeniable. It is one of the main agents causing community meningitis and pneumonia. Invasive pneumococcus infections present high mortality rates. For example, in a Brazilian study, 50% of patients with a bacteremic infection died (1) . Another aggravating factor in the treatment of these infections is the increasing resistance to penicillin and to other antimicrobial drugs commonly used to fight them. There are few Brazilian studies on the prevalence of pneumococcus resistance to penicillin. They were usually carried out in large cities, such as Sao Paulo, Ribeirao Preto, Rio de Janeiro (2-4) , and may not reflect what is occurring in other parts of the country. That is what makes the study published by Spiandorello et al. in this issue of Jornal de Pneumologia so important. Because of the severity of the invasive pneumococcus infection, it is often necessary to start an empirical therapy even before culture and antimicrobial resistance sensitiveness test results are available. Recommendations published in domestic consensus papers and foreign guidelines frequently direct the choice of drugs in this situation. The prevalence of resistance certainly shows a regional variation in Brazil, as it occurs in other countries (5) , and the consensus directions may not apply to different regions or even to different cities or hospitals of the same region. Although resistance to penicillin has rapidly increased over time in many countries,