Emergence of high-level penicillin-resistant streptococcus pneumoniae and cefotaxime treatment failure in immunocompromised patients in Kuwait

ABSTRACT

The emergence of Streptococcus pneumoniae resistant to penicllin [PRP] in different parts of the world has complicated the epidemiology, antimicrobial susceptibility testing and management of serious infections caused by this organism. Experience in the past decade indicates that S. pneumoniae in Kuwait were only relatively resistant to penicillin [MIC>0.5-1.0 micro g/ml]. Recently, however, 2 cases of clinical infections with high-level PRP were encountered at the Cancer Center in Kuwait. The patients involved were a 7-year-old female neutropenic patient who had an overwhelming PRP septicemia and a 70-yearrr-old male patient with chronic lymphocytic leukemia and lower respiratory tract infection. The S. pneumoniae isolates were identified by standard bacteriology methods, and the antimicrobial susceptibility and subsequent interpretation of results were according to the recommended criteria of the National Committee for Clinical Laboratory Standards. With both strains the minimal inhibitory concentration [MIC] of penicillin was 2 micro g/ml each. The MIC of cefotaxime for the isolate from the 7-year-old child was also high [MIC 2 micro g/ml]. This is the first report of PRP with high-level beta-lactam resistance in Kuwait