PNEUMOCOCCAL RESISTANCE TO PENICILLIN - B ACTERIOLOGICAL RESISTANCE VERSUS CLINICAL RESISTANCE

From january 1988 to december 1992, 143 Streptococcus pneumoniae strai ns have been isolated at a significant level from 136 patients hospita lized in the pulmonary care unit of CHI Creteil. The clinical presenta tions were : 83 pneumonia (P), 48 acute bronchitis (B) and 12 colonisa tions (C). Fourteen strains were found to be penicillin resistant (MIC > 0. 125 mg. l-1) : 11 P, 2 B, 1 C. Two patients were lost of view af ter the begining of the treatment : a pneumonia (Serotype 23F, MIC = 2 mg. l-1) and a bronchitis (Serotype 23F, MIC = 2 mg. l-1). Treatment was pristinamycine for one and amoxicilline alone or associated to cla vulanic acid for the other 13. We observed the failure of the treatmen t in two. A pneumonia (Serotype 23, MIC = 2 mg. l-1) was treated befor e hospitalization by josamycine (3 days), then cefpodoxime (4 days) an d amoxicillin-clavulanic acid (1.5 gr/d during 7 days). Healing was ob tained with the increase to 3 gr/d. The other failure was a pneumonia without improvement after 11 days with 3 gr/d of amoxicilline. The tre atment was stopped during 5 days and a protected brushing was performe d. A Streptococcus Pneumoniae (Serotype 23F, MIC = 8 mg. l-1) was isol ated. The clinical status rapidly improved with erythromycine (3gr/d) to which the strain was susceptible. << Bacteriological >> Resistance to penicillin is demonstrated (10 percent in our sample, 17 percent in France during 1991). However amoxicillin to a sufficient dosage is st ill enough (<< Clinical >> Resistance < 1 percent in our sample) for t he treatment of respiratory infections except when the MIC is at a hig h level.