Streptococcus Pneumoniae Resistance to Penicillin Mechanism and Clinical Significance

Streptococcus pneumoniae (S. pneumoniae) is the most commonly identified bacterial cause of meningitis (Schuchat et al., 1997), otitis media and acute sinusitis in adults (Barnett and Klein, 1995; Jacobs, 1996), and community-acquired pneumonia (CAP) at all ages throughout the world (Marston et al., 1997). It is also a frequent cause of bacteremia and one of the most frequent pathogens involved in Chronic Obstructive Pulmonary Disease (COPD) exacerbations.

In the past, approximately 80% of patients hospitalized with bacteremic pneumococcal infections died of their illness (Austrian and Gold, 1964). With effective antimicrobial agents, mortality has decreased, but it remains at nearly 20 percent for elderly adults (Austrian and Gold, 1964; Kramer et al., 1987; Whitney et al., 2000). The principal groups at risk of developing pneumococcal infections are immuno-competent adults with chronic illnesses (cardiovascular, lung, or liver diseases), patients with functional or anatomic asplenia, patients with lymphoproliferative illnesses (chronic lymphatic leukemia, multiple myeloma, and non-Hodgkin lymphoma), and those with congenital deficits of immunoglobulin synthesis. Cigarette smoking is the strongest independent risk factor for invasive pneumococcal disease among immunocompetent, nonelderly adults (Nuorti et al., 1998).

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