Skip to main content
PMC home page
American Journal of Public Health logoLink to American Journal of Public Health
. 2000 Feb;90(2):223–229. doi: 10.2105/ajph.90.2.223

Mortality from invasive pneumococcal pneumonia in the era of antibiotic resistance, 1995-1997.

D R Feikin 1, A Schuchat 1, M Kolczak 1, N L Barrett 1, L H Harrison 1, L Lefkowitz 1, A McGeer 1, M M Farley 1, D J Vugia 1, C Lexau 1, K R Stefonek 1, J E Patterson 1, J H Jorgensen 1
PMCID: PMC1446155  PMID: 10667183

Abstract

OBJECTIVES: This study examined epidemiologic factors affecting mortality from pneumococcal pneumonia in 1995 through 1997. METHODS: Persons residing in a surveillance area who had community-acquired pneumonia requiring hospitalization and Streptococcus pneumoniae isolated from a sterile site were included in the analysis. Factors affecting mortality were evaluated in univariate and multivariate analyses. The number of deaths from pneumococcal pneumonia requiring hospitalization in the United States in 1996 was estimated. RESULTS: Of 5837 cases, 12% were fatal. Increased mortality was associated with older age, underlying disease. Asian race, and residence in Toronto/Peel, Ontario. When these factors were controlled for, increased mortality was not associated with resistance to penicillin or cefotaxime. However, when deaths during the first 4 hospital days were excluded, mortality was significantly associated with penicillin minimum inhibitory concentrations of 4.0 or higher and cefotaxime minimum inhibitory concentrations of 2.0 or higher. In 1996, about 7000 to 12,500 deaths occurred in the United States from pneumococcal pneumonia requiring hospitalization. CONCLUSIONS: Older age and underlying disease remain the most important factors influencing death from pneumococcal pneumonia. Mortality was not elevated in most infections with beta-lactam-resistant pneumococci.

Full Text

The Full Text of this article is available as a PDF (168.0 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. AUSTRIAN R., GOLD J. PNEUMOCOCCAL BACTEREMIA WITH ESPECIAL REFERENCE TO BACTEREMIC PNEUMOCOCCAL PNEUMONIA. Ann Intern Med. 1964 May;60:759–776. doi: 10.7326/0003-4819-60-5-759. [DOI] [PubMed] [Google Scholar]
  2. Afessa B., Greaves W. L., Frederick W. R. Pneumococcal bacteremia in adults: a 14-year experience in an inner-city university hospital. Clin Infect Dis. 1995 Aug;21(2):345–351. doi: 10.1093/clinids/21.2.345. [DOI] [PubMed] [Google Scholar]
  3. Arnold K. E., Leggiadro R. J., Breiman R. F., Lipman H. B., Schwartz B., Appleton M. A., Cleveland K. O., Szeto H. C., Hill B. C., Tenover F. C. Risk factors for carriage of drug-resistant Streptococcus pneumoniae among children in Memphis, Tennessee. J Pediatr. 1996 Jun;128(6):757–764. doi: 10.1016/s0022-3476(96)70326-8. [DOI] [PubMed] [Google Scholar]
  4. Barry A. L., Fuchs P. C., Brown S. D. Macrolide resistance among Streptococcus pneumoniae and Streptococcus pyogenes isolates from out-patients in the USA. J Antimicrob Chemother. 1997 Jul;40(1):139–140. doi: 10.1093/jac/40.1.139. [DOI] [PubMed] [Google Scholar]
  5. Barry B., Muffat-Joly M., Gehanno P., Pocidalo J. J. Effect of increased dosages of amoxicillin in treatment of experimental middle ear otitis due to penicillin-resistant Streptococcus pneumoniae. Antimicrob Agents Chemother. 1993 Aug;37(8):1599–1603. doi: 10.1128/aac.37.8.1599. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Bartlett J. G., Breiman R. F., Mandell L. A., File T. M., Jr Community-acquired pneumonia in adults: guidelines for management. The Infectious Diseases Society of America. Clin Infect Dis. 1998 Apr;26(4):811–838. doi: 10.1086/513953. [DOI] [PubMed] [Google Scholar]
  7. Breiman R. F., Butler J. C., Tenover F. C., Elliott J. A., Facklam R. R. Emergence of drug-resistant pneumococcal infections in the United States. JAMA. 1994 Jun 15;271(23):1831–1835. [PubMed] [Google Scholar]
  8. Bruyn G. A., van der Meer J. W., Hermans J., Knoppert W. Pneumococcal bacteremia in adults over a 10-year period at University Hospital, Leiden. Rev Infect Dis. 1988 Mar-Apr;10(2):446–450. doi: 10.1093/clinids/10.2.446. [DOI] [PubMed] [Google Scholar]
  9. Buckingham S. C., Brown S. P., Joaquin V. H. Breakthrough bacteremia and meningitis during treatment with cephalosporins parenterally for pneumococcal pneumonia. J Pediatr. 1998 Jan;132(1):174–176. doi: 10.1016/s0022-3476(98)70510-4. [DOI] [PubMed] [Google Scholar]
  10. Catalán M. J., Fernández J. M., Vazquez A., Varela de Seijas E., Suárez A., Bernaldo de Quirós J. C. Failure of cefotaxime in the treatment of meningitis due to relatively resistant Streptococcus pneumoniae. Clin Infect Dis. 1994 May;18(5):766–769. doi: 10.1093/clinids/18.5.766. [DOI] [PubMed] [Google Scholar]
  11. Craig W. A., Andes D. Pharmacokinetics and pharmacodynamics of antibiotics in otitis media. Pediatr Infect Dis J. 1996 Mar;15(3):255–259. doi: 10.1097/00006454-199603000-00015. [DOI] [PubMed] [Google Scholar]
  12. Craig W. A. Pharmacokinetic/pharmacodynamic parameters: rationale for antibacterial dosing of mice and men. Clin Infect Dis. 1998 Jan;26(1):1–12. doi: 10.1086/516284. [DOI] [PubMed] [Google Scholar]
  13. Dagan R., Abramson O., Leibovitz E., Lang R., Goshen S., Greenberg D., Yagupsky P., Leiberman A., Fliss D. M. Impaired bacteriologic response to oral cephalosporins in acute otitis media caused by pneumococci with intermediate resistance to penicillin. Pediatr Infect Dis J. 1996 Nov;15(11):980–985. doi: 10.1097/00006454-199611000-00010. [DOI] [PubMed] [Google Scholar]
  14. Duchin J. S., Breiman R. F., Diamond A., Lipman H. B., Block S. L., Hedrick J. A., Finger R., Elliott J. A. High prevalence of multidrug-resistant Streptococcus pneumoniae among children in a rural Kentucky community. Pediatr Infect Dis J. 1995 Sep;14(9):745–750. doi: 10.1097/00006454-199509000-00004. [DOI] [PubMed] [Google Scholar]
  15. Feldman C., Kallenbach J. M., Miller S. D., Thorburn J. R., Koornhof H. J. Community-acquired pneumonia due to penicillin-resistant pneumococci. N Engl J Med. 1985 Sep 5;313(10):615–617. doi: 10.1056/NEJM198509053131006. [DOI] [PubMed] [Google Scholar]
  16. Fine M. J., Smith M. A., Carson C. A., Mutha S. S., Sankey S. S., Weissfeld L. A., Kapoor W. N. Prognosis and outcomes of patients with community-acquired pneumonia. A meta-analysis. JAMA. 1996 Jan 10;275(2):134–141. [PubMed] [Google Scholar]
  17. Friedland I. R. Comparison of the response to antimicrobial therapy of penicillin-resistant and penicillin-susceptible pneumococcal disease. Pediatr Infect Dis J. 1995 Oct;14(10):885–890. doi: 10.1097/00006454-199510000-00013. [DOI] [PubMed] [Google Scholar]
  18. Friedland I. R., McCracken G. H., Jr Management of infections caused by antibiotic-resistant Streptococcus pneumoniae. N Engl J Med. 1994 Aug 11;331(6):377–382. doi: 10.1056/NEJM199408113310607. [DOI] [PubMed] [Google Scholar]
  19. Gehanno P., Lenoir G., Berche P. In vivo correlates for Streptococcus pneumoniae penicillin resistance in acute otitis media. Antimicrob Agents Chemother. 1995 Jan;39(1):271–272. doi: 10.1128/aac.39.1.271. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Hofmann J., Cetron M. S., Farley M. M., Baughman W. S., Facklam R. R., Elliott J. A., Deaver K. A., Breiman R. F. The prevalence of drug-resistant Streptococcus pneumoniae in Atlanta. N Engl J Med. 1995 Aug 24;333(8):481–486. doi: 10.1056/NEJM199508243330803. [DOI] [PubMed] [Google Scholar]
  21. Hook E. W., 3rd, Horton C. A., Schaberg D. R. Failure of intensive care unit support to influence mortality from pneumococcal bacteremia. JAMA. 1983 Feb 25;249(8):1055–1057. [PubMed] [Google Scholar]
  22. Janoff E. N., Breiman R. F., Daley C. L., Hopewell P. C. Pneumococcal disease during HIV infection. Epidemiologic, clinical, and immunologic perspectives. Ann Intern Med. 1992 Aug 15;117(4):314–324. doi: 10.7326/0003-4819-117-4-314. [DOI] [PubMed] [Google Scholar]
  23. Klugman K. P., Friedland I. R., Bradley J. S. Bactericidal activity against cephalosporin-resistant Streptococcus pneumoniae in cerebrospinal fluid of children with acute bacterial meningitis. Antimicrob Agents Chemother. 1995 Sep;39(9):1988–1992. doi: 10.1128/aac.39.9.1988. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Kramer M. R., Rudensky B., Hadas-Halperin I., Isacsohn M., Melzer E. Pneumococcal bacteremia--no change in mortality in 30 years: analysis of 104 cases and review of the literature. Isr J Med Sci. 1987 Mar;23(3):174–180. [PubMed] [Google Scholar]
  25. Liñares J., Alonso T., Pérez J. L., Ayats J., Domínguez M. A., Pallarés R., Martín R. Decreased susceptibility of penicillin-resistant pneumococci to twenty-four beta-lactam antibiotics. J Antimicrob Chemother. 1992 Sep;30(3):279–288. doi: 10.1093/jac/30.3.279. [DOI] [PubMed] [Google Scholar]
  26. Marrie T. J. Bacteraemic pneumococcal pneumonia: a continuously evolving disease. J Infect. 1992 May;24(3):247–255. doi: 10.1016/s0163-4453(05)80029-5. [DOI] [PubMed] [Google Scholar]
  27. Marston B. J., Plouffe J. F., File T. M., Jr, Hackman B. A., Salstrom S. J., Lipman H. B., Kolczak M. S., Breiman R. F. Incidence of community-acquired pneumonia requiring hospitalization. Results of a population-based active surveillance Study in Ohio. The Community-Based Pneumonia Incidence Study Group. Arch Intern Med. 1997 Aug 11;157(15):1709–1718. [PubMed] [Google Scholar]
  28. Mufson M. A. Pneumococcal infections. JAMA. 1981 Oct 23;246(17):1942–1948. [PubMed] [Google Scholar]
  29. Ortqvist A., Grepe A., Julander I., Kalin M. Bacteremic pneumococcal pneumonia in Sweden: clinical course and outcome and comparison with non-bacteremic pneumococcal and mycoplasmal pneumonias. Scand J Infect Dis. 1988;20(2):163–171. doi: 10.3109/00365548809032433. [DOI] [PubMed] [Google Scholar]
  30. Pallares R., Gudiol F., Liñares J., Ariza J., Rufi G., Murgui L., Dorca J., Viladrich P. F. Risk factors and response to antibiotic therapy in adults with bacteremic pneumonia caused by penicillin-resistant pneumococci. N Engl J Med. 1987 Jul 2;317(1):18–22. doi: 10.1056/NEJM198707023170104. [DOI] [PubMed] [Google Scholar]
  31. Pallares R., Liñares J., Vadillo M., Cabellos C., Manresa F., Viladrich P. F., Martin R., Gudiol F. Resistance to penicillin and cephalosporin and mortality from severe pneumococcal pneumonia in Barcelona, Spain. N Engl J Med. 1995 Aug 24;333(8):474–480. doi: 10.1056/NEJM199508243330802. [DOI] [PubMed] [Google Scholar]
  32. Redd S. C., Rutherford G. W., 3rd, Sande M. A., Lifson A. R., Hadley W. K., Facklam R. R., Spika J. S. The role of human immunodeficiency virus infection in pneumococcal bacteremia in San Francisco residents. J Infect Dis. 1990 Nov;162(5):1012–1017. doi: 10.1093/infdis/162.5.1012. [DOI] [PubMed] [Google Scholar]
  33. Schuchat A., Robinson K., Wenger J. D., Harrison L. H., Farley M., Reingold A. L., Lefkowitz L., Perkins B. A. Bacterial meningitis in the United States in 1995. Active Surveillance Team. N Engl J Med. 1997 Oct 2;337(14):970–976. doi: 10.1056/NEJM199710023371404. [DOI] [PubMed] [Google Scholar]
  34. Shriver M. D. Ethnic variation as a key to the biology of human disease. Ann Intern Med. 1997 Sep 1;127(5):401–403. doi: 10.7326/0003-4819-127-5-199709010-00011. [DOI] [PubMed] [Google Scholar]
  35. Sloas M. M., Barrett F. F., Chesney P. J., English B. K., Hill B. C., Tenover F. C., Leggiadro R. J. Cephalosporin treatment failure in penicillin- and cephalosporin-resistant Streptococcus pneumoniae meningitis. Pediatr Infect Dis J. 1992 Aug;11(8):662–666. [PubMed] [Google Scholar]
  36. Tateda K., Takashima K., Miyazaki H., Matsumoto T., Hatori T., Yamaguchi K. Noncompromised penicillin-resistant pneumococcal pneumonia CBA/J mouse model and comparative efficacies of antibiotics in this model. Antimicrob Agents Chemother. 1996 Jun;40(6):1520–1525. doi: 10.1128/aac.40.6.1520. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Visalli M. A., Jacobs M. R., Appelbaum P. C. Susceptibility of penicillin-susceptible and -resistant pneumococci to dirithromycin compared with susceptibilities to erythromycin, azithromycin, clarithromycin, roxithromycin, and clindamycin. Antimicrob Agents Chemother. 1997 Sep;41(9):1867–1870. doi: 10.1128/aac.41.9.1867. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Wennberg J. E., Freeman J. L., Shelton R. M., Bubolz T. A. Hospital use and mortality among Medicare beneficiaries in Boston and New Haven. N Engl J Med. 1989 Oct 26;321(17):1168–1173. doi: 10.1056/NEJM198910263211706. [DOI] [PubMed] [Google Scholar]
  39. Williams W. W., Hickson M. A., Kane M. A., Kendal A. P., Spika J. S., Hinman A. R. Immunization policies and vaccine coverage among adults. The risk for missed opportunities. Ann Intern Med. 1988 Apr;108(4):616–625. doi: 10.7326/0003-4819-108-4-616. [DOI] [PubMed] [Google Scholar]

Articles from American Journal of Public Health are provided here courtesy of American Public Health Association

RESOURCES