Pneumonia caused by penicillin-non-susceptible and penicillin-susceptible pneumococci in adults: a case-control study

2.50
Hdl Handle:
http://hdl.handle.net/2336/47878
Title:
Pneumonia caused by penicillin-non-susceptible and penicillin-susceptible pneumococci in adults: a case-control study
Authors:
Einarsson, S; Kristjansson, M; Kristinsson, K G; Kjartansson, G; Jonsson, S
Citation:
Scand. J. Infect. Dis. 1998, 30(3):253-6
Issue Date:
1-Sep-1998
Abstract:
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.
Description:
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Full metadata record

DC FieldValue Language
dc.contributor.authorEinarsson, S-
dc.contributor.authorKristjansson, M-
dc.contributor.authorKristinsson, K G-
dc.contributor.authorKjartansson, G-
dc.contributor.authorJonsson, S-
dc.date.accessioned2009-01-22T15:04:35Z-
dc.date.available2009-01-22T15:04:35Z-
dc.date.issued1998-09-01-
dc.date.submitted2009-01-22-
dc.identifier.citationScand. J. Infect. Dis. 1998, 30(3):253-6en
dc.identifier.issn0036-5548-
dc.identifier.pmid9790132-
dc.identifier.doi10.1080/00365549850160882-
dc.identifier.urihttp://hdl.handle.net/2336/47878-
dc.descriptionTo access publisher full text version of this article. Please click on the hyperlink in Additional Links fielden
dc.description.abstractThe 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.en
dc.language.isoenen
dc.publisherTaylor & Francisen
dc.relation.urlhttp://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=5233215&site=ehost-liveen
dc.subject.meshAPACHEen
dc.subject.meshAdulten
dc.subject.meshAgeden
dc.subject.meshAnti-Bacterial Agentsen
dc.subject.meshCase-Control Studiesen
dc.subject.meshFemaleen
dc.subject.meshHealth Care Costsen
dc.subject.meshHospitalizationen
dc.subject.meshHumansen
dc.subject.meshIcelanden
dc.subject.meshMaleen
dc.subject.meshMiddle Ageden
dc.subject.meshPenicillin Resistanceen
dc.subject.meshPneumonia, Pneumococcalen
dc.subject.meshRetrospective Studiesen
dc.subject.meshStreptococcus pneumoniaeen
dc.titlePneumonia caused by penicillin-non-susceptible and penicillin-susceptible pneumococci in adults: a case-control studyen
dc.typeArticleen
dc.contributor.departmentDepartment of Medicine and Infectious Diseases, Reykjavik Hospital, Iceland.en
dc.identifier.journalScandinavian journal of infectious diseasesen

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