Effect of Penicillin Resistance on Presentation and Outcome of Nonenterococcal Streptococcal Infective Endocarditis
Background and Aims: Most cases of infective endocarditis are caused by nonenterococcal streptococci. The emergence of strains resistant to penicillin is increasingly recognized worldwide. This study sought to assess the effect of penicillin resistance on presentation and outcome of streptococcal en...
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| Veröffentlicht in: | Cardiology 2006-01, Vol.105 (4), p.234-239 |
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| description | Background and Aims: Most cases of infective endocarditis are caused by nonenterococcal streptococci. The emergence of strains resistant to penicillin is increasingly recognized worldwide. This study sought to assess the effect of penicillin resistance on presentation and outcome of streptococcal endocarditis. Methods: A retrospective study was conducted in a single tertiary care hospital. Results: Between August 1996 and December 2004, patients infected with nonenterococcal streptococcal endocarditis and known minimal inhibitory concentrations (MICs) to penicillin were included in this study. A total of 62 cases were identified: 48 (77%) cases of the streptococcal endocarditis were caused by viridans streptococci. The most common species groups identified were Streptococcus mitis in 12 (19%) cases, Streptococcus oralis in 9 (15%) cases, Streptococcus sanguis in 7 (11%) cases and Streptococcus mutans in 7 (11%) cases. There were 36 male and 26 female patients with a median age of 46 years (range: 1–85). Twenty-two patients (35%) had peripheral embolization and 10 patients (16%) died in hospital. Twenty-eight (45%) of the 62 patients were infected with streptococcal strains of MICs ≧0.125 µg/ml to penicillin. Infection with streptococcal strains of MICs ≧0.125 µg/ml to penicillin was associated with a lower incidence of all-site embolization, but was not associated with higher mortality or increased frequency of surgery. Conclusions: High-level penicillin resistance of the streptococci responsible for endocarditis was increasingly common and medical therapy with vancomycin had a good response. Penicillin resistance was associated with a decreased risk of embolization, but was not associated with higher mortality. |
| doi_str_mv | 10.1159/000091821 |
| format | Article |
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The emergence of strains resistant to penicillin is increasingly recognized worldwide. This study sought to assess the effect of penicillin resistance on presentation and outcome of streptococcal endocarditis. Methods: A retrospective study was conducted in a single tertiary care hospital. Results: Between August 1996 and December 2004, patients infected with nonenterococcal streptococcal endocarditis and known minimal inhibitory concentrations (MICs) to penicillin were included in this study. A total of 62 cases were identified: 48 (77%) cases of the streptococcal endocarditis were caused by viridans streptococci. The most common species groups identified were Streptococcus mitis in 12 (19%) cases, Streptococcus oralis in 9 (15%) cases, Streptococcus sanguis in 7 (11%) cases and Streptococcus mutans in 7 (11%) cases. There were 36 male and 26 female patients with a median age of 46 years (range: 1–85). Twenty-two patients (35%) had peripheral embolization and 10 patients (16%) died in hospital. Twenty-eight (45%) of the 62 patients were infected with streptococcal strains of MICs ≧0.125 µg/ml to penicillin. Infection with streptococcal strains of MICs ≧0.125 µg/ml to penicillin was associated with a lower incidence of all-site embolization, but was not associated with higher mortality or increased frequency of surgery. Conclusions: High-level penicillin resistance of the streptococci responsible for endocarditis was increasingly common and medical therapy with vancomycin had a good response. Penicillin resistance was associated with a decreased risk of embolization, but was not associated with higher mortality.</description><identifier>ISSN: 0008-6312</identifier><identifier>EISSN: 1421-9751</identifier><identifier>DOI: 10.1159/000091821</identifier><identifier>PMID: 16534200</identifier><language>eng</language><publisher>Basel, Switzerland: S. Karger AG</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Bacteria ; Cardiology ; Chi-Square Distribution ; Child ; Child, Preschool ; Clinical outcomes ; Drug resistance ; Drug Resistance, Bacterial ; Endocarditis, Bacterial - drug therapy ; Endocarditis, Bacterial - microbiology ; Female ; Humans ; Infant ; Infections ; Logistic Models ; Male ; Microbial Sensitivity Tests ; Middle Aged ; Original Research ; Penicillin ; Penicillin Resistance ; Pulmonary Embolism - microbiology ; Retrospective Studies ; Risk Factors ; Statistics, Nonparametric ; Streptococcal Infections - drug therapy ; Streptococcal Infections - microbiology ; Streptococcus ; Streptococcus mitis ; Streptococcus mitis - drug effects ; Streptococcus mutans ; Streptococcus mutans - drug effects ; Streptococcus oralis ; Streptococcus oralis - drug effects ; Streptococcus sanguinis ; Streptococcus sanguis - drug effects ; Treatment Outcome ; Vancomycin - therapeutic use</subject><ispartof>Cardiology, 2006-01, Vol.105 (4), p.234-239</ispartof><rights>2006 S. Karger AG, Basel</rights><rights>Copyright 2006 S. Karger AG, Basel.</rights><rights>Copyright (c) 2006 S. Karger AG, Basel</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c427t-e300990cf2876b60044ae31509eeecff9b4b46aebe56af90334dd214e77a245c3</citedby><cites>FETCH-LOGICAL-c427t-e300990cf2876b60044ae31509eeecff9b4b46aebe56af90334dd214e77a245c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,2429,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16534200$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hsu, Ron-Bin</creatorcontrib><creatorcontrib>Lin, Fang-Yue</creatorcontrib><title>Effect of Penicillin Resistance on Presentation and Outcome of Nonenterococcal Streptococcal Infective Endocarditis</title><title>Cardiology</title><addtitle>Cardiology</addtitle><description>Background and Aims: Most cases of infective endocarditis are caused by nonenterococcal streptococci. The emergence of strains resistant to penicillin is increasingly recognized worldwide. This study sought to assess the effect of penicillin resistance on presentation and outcome of streptococcal endocarditis. Methods: A retrospective study was conducted in a single tertiary care hospital. Results: Between August 1996 and December 2004, patients infected with nonenterococcal streptococcal endocarditis and known minimal inhibitory concentrations (MICs) to penicillin were included in this study. A total of 62 cases were identified: 48 (77%) cases of the streptococcal endocarditis were caused by viridans streptococci. The most common species groups identified were Streptococcus mitis in 12 (19%) cases, Streptococcus oralis in 9 (15%) cases, Streptococcus sanguis in 7 (11%) cases and Streptococcus mutans in 7 (11%) cases. There were 36 male and 26 female patients with a median age of 46 years (range: 1–85). Twenty-two patients (35%) had peripheral embolization and 10 patients (16%) died in hospital. Twenty-eight (45%) of the 62 patients were infected with streptococcal strains of MICs ≧0.125 µg/ml to penicillin. Infection with streptococcal strains of MICs ≧0.125 µg/ml to penicillin was associated with a lower incidence of all-site embolization, but was not associated with higher mortality or increased frequency of surgery. Conclusions: High-level penicillin resistance of the streptococci responsible for endocarditis was increasingly common and medical therapy with vancomycin had a good response. Penicillin resistance was associated with a decreased risk of embolization, but was not associated with higher mortality.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Bacteria</subject><subject>Cardiology</subject><subject>Chi-Square Distribution</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Clinical outcomes</subject><subject>Drug resistance</subject><subject>Drug Resistance, Bacterial</subject><subject>Endocarditis, Bacterial - drug therapy</subject><subject>Endocarditis, Bacterial - microbiology</subject><subject>Female</subject><subject>Humans</subject><subject>Infant</subject><subject>Infections</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Microbial Sensitivity Tests</subject><subject>Middle Aged</subject><subject>Original Research</subject><subject>Penicillin</subject><subject>Penicillin Resistance</subject><subject>Pulmonary Embolism - microbiology</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Statistics, Nonparametric</subject><subject>Streptococcal Infections - drug therapy</subject><subject>Streptococcal Infections - microbiology</subject><subject>Streptococcus</subject><subject>Streptococcus mitis</subject><subject>Streptococcus mitis - drug effects</subject><subject>Streptococcus mutans</subject><subject>Streptococcus mutans - drug effects</subject><subject>Streptococcus oralis</subject><subject>Streptococcus oralis - drug effects</subject><subject>Streptococcus sanguinis</subject><subject>Streptococcus sanguis - drug effects</subject><subject>Treatment Outcome</subject><subject>Vancomycin - therapeutic use</subject><issn>0008-6312</issn><issn>1421-9751</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2006</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkc1LAzEQxYMotlYPngVZPAgeVpNsdtM9SqlaKLb4cV6y2YmkbpOaZAX_e1NaK3gxl_Ayv3lk5iF0SvA1IXl5g-MpyZCSPdQnjJK05DnZR_34PEyLjNAeOvJ-ESXjjB6iHinyjFGM-8iPlQIZEquSORgtddtqkzyB1z4IIyGxJpk78GCCCDoKYZpk1gVpl7BuerQmlsBZaaUUbfIcHKzCj5qYtbn-hGRsGiuFa3TQ_hgdKNF6ONneA_R6N34ZPaTT2f1kdDtNJaM8pJDFqUosFR3yoi7i55mAjOS4BACpVFmzmhUCasgLoUqcZaxpKGHAuaAsl9kAXW58V85-dOBDtdReQtsKA7bzVcHLHGc4_xekBMc102EEL_6AC9s5E4eoKGccFzGDCF1tIOms9w5UtXJ6KdxXRXC1zqva5RXZ861hVy-h-SW3AUXgbAO8C_cGbgds2r8BuVGZFQ</recordid><startdate>20060101</startdate><enddate>20060101</enddate><creator>Hsu, Ron-Bin</creator><creator>Lin, Fang-Yue</creator><general>S. Karger AG</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7QL</scope><scope>C1K</scope><scope>7X8</scope></search><sort><creationdate>20060101</creationdate><title>Effect of Penicillin Resistance on Presentation and Outcome of Nonenterococcal Streptococcal Infective Endocarditis</title><author>Hsu, Ron-Bin ; Lin, Fang-Yue</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c427t-e300990cf2876b60044ae31509eeecff9b4b46aebe56af90334dd214e77a245c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2006</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Bacteria</topic><topic>Cardiology</topic><topic>Chi-Square Distribution</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Clinical outcomes</topic><topic>Drug resistance</topic><topic>Drug Resistance, Bacterial</topic><topic>Endocarditis, Bacterial - drug therapy</topic><topic>Endocarditis, Bacterial - microbiology</topic><topic>Female</topic><topic>Humans</topic><topic>Infant</topic><topic>Infections</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Microbial Sensitivity Tests</topic><topic>Middle Aged</topic><topic>Original Research</topic><topic>Penicillin</topic><topic>Penicillin Resistance</topic><topic>Pulmonary Embolism - microbiology</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Statistics, Nonparametric</topic><topic>Streptococcal Infections - drug therapy</topic><topic>Streptococcal Infections - microbiology</topic><topic>Streptococcus</topic><topic>Streptococcus mitis</topic><topic>Streptococcus mitis - drug effects</topic><topic>Streptococcus mutans</topic><topic>Streptococcus mutans - drug effects</topic><topic>Streptococcus oralis</topic><topic>Streptococcus oralis - drug effects</topic><topic>Streptococcus sanguinis</topic><topic>Streptococcus sanguis - drug effects</topic><topic>Treatment Outcome</topic><topic>Vancomycin - therapeutic use</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hsu, Ron-Bin</creatorcontrib><creatorcontrib>Lin, Fang-Yue</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Environmental Sciences and Pollution Management</collection><collection>MEDLINE - Academic</collection><jtitle>Cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hsu, Ron-Bin</au><au>Lin, Fang-Yue</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of Penicillin Resistance on Presentation and Outcome of Nonenterococcal Streptococcal Infective Endocarditis</atitle><jtitle>Cardiology</jtitle><addtitle>Cardiology</addtitle><date>2006-01-01</date><risdate>2006</risdate><volume>105</volume><issue>4</issue><spage>234</spage><epage>239</epage><pages>234-239</pages><issn>0008-6312</issn><eissn>1421-9751</eissn><abstract>Background and Aims: Most cases of infective endocarditis are caused by nonenterococcal streptococci. The emergence of strains resistant to penicillin is increasingly recognized worldwide. This study sought to assess the effect of penicillin resistance on presentation and outcome of streptococcal endocarditis. Methods: A retrospective study was conducted in a single tertiary care hospital. Results: Between August 1996 and December 2004, patients infected with nonenterococcal streptococcal endocarditis and known minimal inhibitory concentrations (MICs) to penicillin were included in this study. A total of 62 cases were identified: 48 (77%) cases of the streptococcal endocarditis were caused by viridans streptococci. The most common species groups identified were Streptococcus mitis in 12 (19%) cases, Streptococcus oralis in 9 (15%) cases, Streptococcus sanguis in 7 (11%) cases and Streptococcus mutans in 7 (11%) cases. There were 36 male and 26 female patients with a median age of 46 years (range: 1–85). Twenty-two patients (35%) had peripheral embolization and 10 patients (16%) died in hospital. Twenty-eight (45%) of the 62 patients were infected with streptococcal strains of MICs ≧0.125 µg/ml to penicillin. Infection with streptococcal strains of MICs ≧0.125 µg/ml to penicillin was associated with a lower incidence of all-site embolization, but was not associated with higher mortality or increased frequency of surgery. Conclusions: High-level penicillin resistance of the streptococci responsible for endocarditis was increasingly common and medical therapy with vancomycin had a good response. Penicillin resistance was associated with a decreased risk of embolization, but was not associated with higher mortality.</abstract><cop>Basel, Switzerland</cop><pub>S. Karger AG</pub><pmid>16534200</pmid><doi>10.1159/000091821</doi><tpages>6</tpages></addata></record> |
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| subjects | Adolescent Adult Aged Aged, 80 and over Bacteria Cardiology Chi-Square Distribution Child Child, Preschool Clinical outcomes Drug resistance Drug Resistance, Bacterial Endocarditis, Bacterial - drug therapy Endocarditis, Bacterial - microbiology Female Humans Infant Infections Logistic Models Male Microbial Sensitivity Tests Middle Aged Original Research Penicillin Penicillin Resistance Pulmonary Embolism - microbiology Retrospective Studies Risk Factors Statistics, Nonparametric Streptococcal Infections - drug therapy Streptococcal Infections - microbiology Streptococcus Streptococcus mitis Streptococcus mitis - drug effects Streptococcus mutans Streptococcus mutans - drug effects Streptococcus oralis Streptococcus oralis - drug effects Streptococcus sanguinis Streptococcus sanguis - drug effects Treatment Outcome Vancomycin - therapeutic use |
| title | Effect of Penicillin Resistance on Presentation and Outcome of Nonenterococcal Streptococcal Infective Endocarditis |
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