       Document 0416
 DOCN  M9610416
 TI    Penicillin-resistant pneumococci--an emerging threat to successful
       therapy.
 DT    9601
 AU    McGowan JE Jr; Metchock BG; Department of Pathology and Laboratory
       Medicine, Emory University; School of Medicine, Atlanta, Georgia, USA.
 SO    J Hosp Infect. 1995 Jun;30 Suppl:472-82. Unique Identifier : AIDSLINE
       MED/96035377
 AB    Pneumococci highly resistant to penicillin G [minimum inhibitory
       concentration (MIC) > or = 2 mg L-1] have become prevalent in many parts
       of the world since their emergence and spread in the late 1970s. In the
       USA, such organisms are seen primarily in two populations: infants and
       children, and adults with AIDS. Surveys in both rural and urban areas
       have revealed presence of these organisms, as well as an increasing
       frequency of Streptococcus pneumoniae strains relatively resistant to
       penicillin (MIC 0.1-1.0 mg L-1--now defined by some as 'intermediate'
       resistance). Predisposing factors are not yet clear. Prior antimicrobial
       therapy was given to some of the children and most of the adults who are
       colonized or infected with resistant strains. Prior or concurrent use of
       cotrimoxazole prophylaxis for Pneumocystis carinii pneumonia has been
       frequent in our cases in adults, most of whom had a concurrent diagnosis
       of AIDS. Children with disease often have a history of long-term
       prophylaxis with a beta-lactam drug (for sickle cell disease, etc). Many
       strains are also resistant to newer cephalosporins like cefotaxime and
       ceftriaxone (MIC > or = 2 mg L-1). The organisms are frequently
       multi-resistant, with high MIC values common as well for chloramphenicol
       and variable for tetracycline, macrolides, cotrimoxazole, and
       fluoroquinolones. Only to vancomycin are the organisms consistently
       susceptible. These findings raise alarms about the future of
       pneumococcal disease in both community and nosocomial disease.
       Increasing prevalence in otitis and pneumonia in children and in
       community-acquired pneumonia in adults may lead to use of vancomycin as
       empirical therapy for these clinical situations. This would increase the
       selective pressure for emergence of vancomycin-resistant organisms,
       whether S. pneumoniae or others. Moreover, the pneumococcus was a common
       cause of hospital infection prior to the introduction of penicillin. The
       potential now exists for nosocomial pneumococcal infection again to
       become a feared and ominous occurrence.
 DE    Adolescence  Adult  Aged  AIDS-Related Opportunistic
       Infections/*MICROBIOLOGY  Child  Child, Preschool  Community-Acquired
       Infections/MICROBIOLOGY  Cross Infection/*MICROBIOLOGY  Drug Resistance,
       Multiple  Human  Infant  Middle Age  Otitis/MICROBIOLOGY  Penicillin
       G/*PHARMACOLOGY  Penicillin Resistance  Penicillins/*PHARMACOLOGY
       Pneumococcal Infections/*MICROBIOLOGY  Pneumonia, Lobar/MICROBIOLOGY
       Risk Factors  Streptococcus pneumoniae/*DRUG EFFECTS  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

