EPIDEMIOLOGIC FEATURES OF AND RISK-FACTORS FOR INFECTION BY STREPTOCOCCUS-PNEUMONIAE STRAINS WITH DIMINISHED SUSCEPTIBILITY TO PENICILLIN -FINDINGS OF A FRENCH SURVEY

A nationwide retrospective study was performed in France to describe t he susceptibility of Streptococcus pneumoniae strains to penicillin G and to identify risk factors for infection with nonsusceptible strains . From January 1991 to May 1992, 10,350 S. pneumoniae strains were rec orded. The overall rate of penicillin-nonsusceptible pneumococcal (PNS P) strains was 11%; specific prevalence rates, according to the source s of the isolates, were as follows: blood, 6%; cerebrospinal fluid, 10 %; lower respiratory tract, 10%; and middle ear, 18%. Large variations in regional distribution were observed. In 85% of cases, PNSP strains belonged to serogroup 23, 19, 6, 14, or 9, by order of decreasing fre quency, A logistic regression model identified the following factors a s being associated with PNSP infections: age of <15 years (OR = 2.01), isolation of the organisms from the upper respiratory tract (OR = 2.3 6) or from sinus and middle ear (OR = 1.63), HIV infection (OR = 2.01) , beta-lactam antimicrobial therapy in the previous 6 months (OR = 1.9 9), and nosocomial acquisition (OR = 2.12), The attributable risk of b eta-lactam antimicrobial therapy in the previous 6 months was 19%, sho wing that suppression of this factor alone could not eradicate PNSP in fections.