OBJECTIVE: The study aimed to evaluate the prevalence, clinical significance and outcome of community-acquired penicillin-resistant Streptococcus pneumoniae (PRSP) pneumonia in Thailand. METHODOLOGY: We conducted a prospective study in culture-proven pneumococcal pneumonia. Pneumococci were defined as susceptible, intermediate resistance and high resistance according to the definitions of the United States National Committee for Clinical Laboratory Standards (NCCLS). RESULTS: Forty-six consecutive patients were enrolled. Of the S. pneumoniae isolates collected, 41.3% were resistant to penicillin (37% intermediate resistance and 4.3% high resistance). Resistance to other antibiotics was 13% to ceftriaxone (8.7% intermediate resistance and 4.3% high resistance), 34.8% to erythromycin, 39.1% to tetracycline, 26.1% to chloramphenicol, and 43.5% to trimethoprim -sulfamethoxazole. Prior antibiotic use within 3 months was significantly associated with resistance to penicillin. The overall mortality of pneumococcal pneumonia was 26.1%. Multilobar involvement and requirement for mechanical ventilation proved to be associated with mortality. However, resistance to penicillin or ceftriaxone was not associated with death. CONCLUSIONS: According to the US NCCLS guidelines, we found a high prevalence of drug-resistant S. pneumoniae in Thai patients with community-acquired pneumonia. Prior antibiotic use was significantly associated with penicillin resistance. However, the outcome was not related to in vitro penicillin susceptibility of S. pneumoniae isolated from the patients.
OBJECTIVE: The study aimed to evaluate the prevalence, clinical significance and outcome of community-acquired penicillin-resistant Streptococcus pneumoniae (PRSP) pneumonia in Thailand. METHODOLOGY: We conducted a prospective study in culture-proven pneumococcal pneumonia. Pneumococci were defined as susceptible, intermediate resistance and high resistance according to the definitions of the United States National Committee for Clinical Laboratory Standards (NCCLS). RESULTS: Forty-six consecutive patients were enrolled. Of the S. pneumoniae isolates collected, 41.3% were resistant to penicillin (37% intermediate resistance and 4.3% high resistance). Resistance to other antibiotics was 13% to ceftriaxone (8.7% intermediate resistance and 4.3% high resistance), 34.8% to erythromycin, 39.1% to tetracycline, 26.1% to chloramphenicol, and 43.5% to trimethoprim -sulfamethoxazole. Prior antibiotic use within 3 months was significantly associated with resistance to penicillin. The overall mortality of pneumococcal pneumonia was 26.1%. Multilobar involvement and requirement for mechanical ventilation proved to be associated with mortality. However, resistance to penicillin or ceftriaxone was not associated with death. CONCLUSIONS: According to the US NCCLS guidelines, we found a high prevalence of drug-resistant S. pneumoniae in Thai patients with community-acquired pneumonia. Prior antibiotic use was significantly associated with penicillin resistance. However, the outcome was not related to in vitro penicillin susceptibility of S. pneumoniae isolated from the patients.