Impact of Cefotaxime Non-susceptibility on the Clinical Outcomes of Bacteremic Pneumococcal Pneumonia.

Cillóniz Cillóniz,Marco Marco,De La Calle De La Calle,Soriano Soriano,Torres Torres,García-Vidal García-Vidal,Dominedò Dominedò,Cardozo Cardozo,Gabarrús Gabarrús

doi:10.3390/jcm8081150

Abstract

Background: We aimed to analyze the impact of cefotaxime non-susceptibility on the 30-day mortality rate in patients receiving a third-generation cephalosporin for pneumococcal bacteremic pneumonia. Methods: We conducted a retrospective observational study of prospectively collected data from the Hospital Clinic of Barcelona. All adult patients with monomicrobial bacteremic pneumonia due to Streptococcus pneumoniae and treated with a third-generation cephalosporin from January 1991 to December 2016 were included. Risk factors associated with 30-day mortality were evaluated by univariate and multivariate analyses. Results: During the study period, 721 eligible episodes were identified, and data on the susceptibility to cefotaxime was obtainable for 690 episodes. Sixty six (10%) cases were due to a cefotaxime non-susceptible strain with a 30-day mortality rate of 8%. Variables associated with 30-day mortality were age, chronic liver disease, septic shock, and the McCabe score. Infection by a cefotaxime non-susceptible S. pneumoniae did not increase the mortality rate. Conclusion: Despite the prevalence of cefotaxime, non-susceptible S. pneumoniae has increased in recent years. We found no evidence to suggest that patients hospitalized with bacteremic pneumonia due to these strains had worse clinical outcomes than patients with susceptible strains.

Highlights

Streptococcus pneumoniae is considered the main cause of non-invasive and invasive infectious diseases that are associated with high morbidity and case fatality rate worldwide, especially in vulnerable populations, such as children and adults aged > 65 years [1,2,3]
Several studies reported a reduction in the proportion of invasive pneumococcal disease caused by antibiotic resistant pneumococcal strains; during recent years we have observed serotype replacement, emergence of non-vaccine serotypes, and infections caused by non-encapsulated pneumococcus [5,6,7]
We identified 721 episodes of monomicrobial bacteremic pneumococcal pneumonia; of these, 31 were excluded because they were missing important data

Summary

Introduction

Streptococcus pneumoniae (pneumococcus) is considered the main cause of non-invasive and invasive infectious diseases that are associated with high morbidity and case fatality rate worldwide, especially in vulnerable populations, such as children and adults aged > 65 years [1,2,3]. Several studies reported a reduction in the proportion of invasive pneumococcal disease caused by antibiotic resistant pneumococcal strains; during recent years we have observed serotype replacement, emergence of non-vaccine serotypes, and infections caused by non-encapsulated pneumococcus [5,6,7]. We aimed to analyze the impact of cefotaxime non-susceptibility on the 30-day mortality rate in patients receiving a third-generation cephalosporin for pneumococcal bacteremic pneumonia. Infection by a cefotaxime non-susceptible S. pneumoniae did not increase the mortality rate. We found no evidence to suggest that patients hospitalized with bacteremic pneumonia due to these strains had worse clinical outcomes than patients with susceptible strains

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