A HOSPITAL OUTBREAK OF PENICILLIN-RESISTANT PNEUMOCOCCI IN THE NETHERLANDS

Respiratory infections with penicillin resistant pneumococci constitut e an increasing health care problem. This paper describes the nosocomi al spread of penicillin resistant pneumococci (PRP) on a pulmonary war d. During an eight-month period, minimal inhibitory concentrations (MI Cs) for penicillin and several other antibiotics were performed on ah Streptococcus pneumoniae isolates that were shown to be penicillin res istant by a screening assay. The personal data and case history of all patients with penicillin resistant pneumococci were evaluated. Penici llin Resistant Pneumococci were cultured from 18 patients, 16 men (mea n age 74+/-8 yrs) and 2 women (aged 54 and 60 yrs). Chronic obstructiv e pulmonary disease was diagnosed in 16 patients, 10 of which had an a dditional underlying disease (2 diabetes mellitus, 2 heart failure, 2 malignancy). Prior to culture of Penicillin Resistant Pneumococci, 11 out of 18 patients were treated with antibiotics, a beta-lactam in mos t instances. Ten out of 18 patients died during or shortly after hospi talization. The death of one patient seems to be directly related to i nfection with Pencillin Resistant Pneumococci. The five Penicillin Res istant Pneumococci isolates available for serotyping were all type 9. The minimal inhibitory concentrations for penicillin varied from 0.5 t o 2.0 mg.l(-1). High minimal inhibitory concentrations were also noted for cefixime (all over 4.0 mg.l(-1)) and ceftriaxone (0.5-1.0 mg.l(-1 )). It is concluded that penicillin resistant pneumococci can spread r apidly among old and debilitated patients. Thus, patients with this in fection should be barrier nursed.