Clinical outcomes of bacteremic pneumococcal pneumonia in the era of antibiotic resistance

Limited data are available about the impact of antimicrobial resistance on clinical outcomes in cases of pneumococcal pneumonia. This was studied in 1 46 persons hospitalized with invasive pneumonia due to Streptococcus pneumo niae (minimum inhibitory concentration of cefotaxime, greater than or equal to 25 mug/mL) who were identified through population-based active surveill ance for the period of November 1994 through April 1996. Compared with matc hed control subjects who had infection with more-susceptible S. pneumoniae, the proportion of subjects who died or who were admitted to an intensive c are unit did not differ significantly. Multivariable analysis showed no sig nificant contribution of antimicrobial resistance to mortality or the requi rement for care in an intensive care unit. The ability to detect an effect of antimicrobial resistance on these important outcome measures may have be en influenced by aggressive multidrug empirical therapy in this group of ho spitalized patients. Factors other than resistance, such as severity of ill ness at presentation and advance directive status ("do not resuscitate" ord ers), appear to have a stronger influence on pneumococcal pneumonia outcome s.