RESUMO
The increasing reporting of Streptococcus pneumoniae resistance to penicillin has lead to the recommendation of third generation cephalospirins for the treatment of serious pneumococcal infections. As a consequence, clinicians usually do not prescribe first line antibiotics despiste the availability of susceptibility studies. Whit the aim to evaluate the impact of the infectious diseases specialist evaluation in the apropriate use oh the susceptibility studies, two series were compared: a historic control one (1998-2002, n = 50) and a prospectuve group that had the advisement of one infectious diseases specialist (2003-2006, n = 60). In both series, pneumonia stood out as the source of the bacteremia, and -alcoholism/hepatic insufficiency as associated factor. In the first series, 48 isolates resulted susceptible to penicillin by agar diffusion, and 1 out of 36 patients with pneumonia had a change in the antibiotic therapy to penicillin. In the prospective series, we found 56 susceptible isolates, and the remaining four were classified as intermediate susceptibility according to the MIC value. Antibiotics were changed in 36 out of 50 patients with bacteremic pneumococcal pneumonia (p < 0.05). The infectious diseases specialist evaluation had a positive impact on the use of the microbiological information for therapeutics purposes.
Assuntos
Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Pneumonia Pneumocócica/tratamento farmacológico , Streptococcus pneumoniae/efeitos dos fármacos , Adulto , Bacteriemia/microbiologia , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Resistência às Penicilinas , Estudos ProspectivosRESUMO
The increasing reporting of Streptococcus pneumoniae resistance to penicillin has lead to the recommendation of third generation cephalospirins for the treatment of serious pneumococcal infections. As a consequence, clinicians usually do not prescribe first line antibiotics despiste the availability of susceptibility studies. Whit the aim to evaluate the impact of the infectious diseases specialist evaluation in the apropriate use oh the susceptibility studies, two series were compared: a historic control one (1998-2002, n = 50) and a prospectuve group that had the advisement of one infectious diseases specialist (2003-2006, n = 60). In both series, pneumonia stood out as the source of the bacteremia, and -alcoholism/hepatic insufficiency as associated factor. In the first series, 48 isolates resulted susceptible to penicillin by agar diffusion, and 1 out of 36 patients with pneumonia had a change in the antibiotic therapy to penicillin. In the prospective series, we found 56 susceptible isolates, and the remaining four were classified as intermediate susceptibility according to the MIC value. Antibiotics were changed in 36 out of 50 patients with bacteremic pneumococcal pneumonia (p < 0.05). The infectious diseases specialist evaluation had a positive impact on the use of the microbiological information for therapeutics purposes.
La descripción creciente de Streptococcus pneu-moniae resistente a penicilina, ha llevado a la recomendación de emplear cefalosporinas de tercera generación para el tratamiento de las infecciones neumo-cócicas graves. Como consecuencia, los médicos clínicos no prescriben, usualmente, antimicrobianos de primera línea, a pesar de disponer de estudios de susceptibilidad in vitro. Con el propósito de evaluar el impacto de la asesoría del infectólogo para el uso adecuado de los estudios de susceptibilidad, se compararon dos series: un control histórico (1998-2002, n = 50) y un grupo prospectivo en que sí hubo asesoría infectológica (2003-2006, n = 60). En ambas series, la neumonía fue el foco principal de bacteriemia y alcoholismo/falla hepática los factores asociados más frecuentes. En el primer grupo, 48 aislados resultaron susceptibles a penicilina por prueba de difusión en agar y en uno de 36 pacientes con neumonía, se efectuó cambio en la terapia antimicrobiana a bencilpeni-cilina. En el grupo prospectivo, hubo 56 cepas susceptibles y las cuatro restantes fueron clasificadas como de susceptibilidad intermedia, de acuerdo con los valores de CIM. Se cambió de antimicrobiano en 36 de 50 pacientes con neumonía neumocóccica bacteriémica (p < 0,05). La evaluación hecha por el infectólogo tuvo un impacto positivo en el uso de información micro-biológica con fines terapéuticos.
