Letters to the Editor Cefuroxime Efficacy in Treatment of Bacteremic Pneumonia Due to Penicillin- Resistant and Cefuroxime-Resistant Streptococcus pneumoniae

Because of treatment failure with the use of third-generation cephalosporins for penicillin-resistant pneumococcal meningi-tis, the National Committee for Clinical Laboratory Standards (NCCLS) amended the resistance interpretive criteria for Streptococcus pneumoniae (7). According to the 1993 criteria, strains for which the cefuroxime sodium MIC is $2 mg/ml are considered resistant. The newest recommendations by the NCCLS (8), based on Jorgensen et al. (5), do not specify modifications for cefuroxime sodium. Penicillin-resistant pneumococcal pneumonia does not raise as serious a problem as meningitis does. High-dose penicillin G is effective against resistant strains for which penicillin MICs are up to 2 mg/ml, and ceftriaxone or cefotaxime may be useful when the penicillin MIC is higher (10). However, despite these recent suggestions, appropriate guidelines for the management of this infection with penicillin or other b-lactams have not been established. Second-generation cephalosporins are recommended for the initial management of community-acquired pneumonia with comorbidity or for patients $60 years of age (9), and cefuroxime has been suggested recently as empiric therapy for acute human immunodeficiency virus (HIV)-associated bacte-rial pneumonia (1). Nevertheless, reports of cefuroxime ther-apy for penicillin-resistant pneumococcal pneumonia are very limited, and they do not include cefuroxime-resistant cases (12). This report is our experience with cefuroxime sodium in the treatment of bacteremic pneumococcal pneumonia caused by penicillin- and cefuroxime-resistant strains. Among the patients with serious S. pneumoniae infections diagnosed during the last 5 years in our hospital, we identified 21 penicillin- and cefuroxime-resistant pneumococcal strains. MICs were determined by using the agar-dilution method. Three of these 21 strains were isolated from blood cultures of patients with community-acquired pneumonia who received intravenous cefuroxime sodium as therapy. The characteristics of these three patients, the MICs of b-lactam antibiotics, treatment, and outcome are summarize