TREATMENT OF PENICILLIN-RESISTANT PNEUMOCOCCAL BACTEREMIA IN NEUTROPENIC PATIENTS WITH CANCER

We identified 17 cases of pneumococcal bacteremia among 340 neutropeni c cancer patients with bacteremia. Pneumonia was more frequent in pati ents with pneumococcal bacteremia than in those with bacteremia due to other organisms: 12 (71%) of 17 patients with pneumococcal bacteremia had pneumonia, whereas only 23 (7%) of 323 patients with nonpneumococ cal bacteremia had pneumonia (P < .001). Eight (47%) of the 17 episode s of pneumococcal bacteremia were caused by penicillin-resistant strai ns (MICs ranged from 0.12 mu g/mL to 4 mu g/mL; these penicillin-resis tant pneumococci showed varying degrees of diminished susceptibility t o all beta-lactams studied, especially ceftazidime (MICs of this drug ranged from 1 mu g/mL to 64 mu g/mL). Imipenem was the beta-lactam age nt most active against these organisms (MICs ranged from 0.03 mu g/mL to 0.25 mu g/mL). Patients with penicillin-resistant pneumococcal bact eremia received inappropriate empirical antibiotic therapy more often than did patients with bacteremia due to susceptible strains (i.e., 4 (50%) of 8 patients vs. 0 of 9, respectively; P < .05). Eight (47%) of the 17 patients with pneumococcal bacteremia died. In areas where pen icillin-resistant pneumococci are highly endemic, these findings shoul d be considered in selecting empirical antibiotic therapy for neutrope nic patients with cancer who are suspected of having pneumonia.