Chest
Clinical InvestigationsINFECTIONThe Impact of Blood Cultures on Antibiotic Therapy in Pneumococcal Pneumonia
Section snippets
Materials and Methods
The medical records of all patients admitted to Methodist Healthcare Central Hospital in Memphis between January 1996 and December 1998 with an admission diagnosis of CAP and at least one positive blood culture for S pneumoniae were retrospectively reviewed. In addition to demographic data, the initial antibiotic treatment, culture results, subsequent modification of treatment, complications, and outcome were recorded. Clinical data sufficient to calculate both the APACHE (acute physiology and
Results
During the review period, 1,805 patients were admitted with a diagnosis of CAP. Of 118 patients identified with positive blood culture results for S pneumoniae, 105 charts were available for review. Seventy-four of these patients (42 female and 32 male) were admitted for CAP; these comprised the study group. Nine of these patients (12.1%) reported a penicillin allergy. Sources of the pneumococcal septicemia in the other 31 patients were meningitis,8 infective endocarditis (2 patients), other (8
Discussion
Not only does the frequent indiscriminate use of broad-spectrum antibiotics increase the cost of treating CAP, it is also very likely a major factor in the growing problem of antibiotic resistance in many bacterial pathogens, particularly Gram-negative organisms such as Pseudomonas aeruginosa and Acinetobacter sp.10 Penicillin, when the pneumococcal strain identified is fully sensitive, is at least as efficacious as the higher-cost broader spectrum agents, such as third generation
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Dr. Waterer has been supported by a grant from the Methodist-Le Bonheur Healthcare Foundation and by the Athelstan and Amy Saw Medical Research Fellowship from the University of Western Australia.
For editorial comment see page 1153.