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Infectious Diseases Section and Clinical Significance of Streptococcus Pneumoniae Resistance Reporting Remains Confusing

25 of these patients received discordant therapy. Furthermore, only 14 patients received discordant therapy with penicillin or cefotaxime/ceftriaxone, since the other 11 received cefuroxime initially. However, the main conclusion of Yu et al. [1] (last paragraph) is based on results for these 14 patients. Finally, Yu et al. [1] did not analyze the outcomes for patients infected separately with intermediately susceptible and resistant strains. It is well known that nonmeningeal pneumococcal infections caused by strains with penicillin MICs of 2 mg/mL can be successfully treated with penicillin, but this is not clear for strains with higher MICs [2]. No difference in mortality rates was found in 2 studies of nonmeningeal pneumococcal infections caused by strains susceptible and resistant to cefotaxime/ceftriaxone [3,4] and treated with these antimicrobials. The first of these studies [3] only included 5 isolates with cefotaxime/ceftriaxone MICs of 2 mg/ mL and 1 isolate with an MIC of 4 mg/ mL. In the second study [4], none of the isolates had MICs of 12 mg/mL. So it is also important to know the number of patients separately infected with resistant and intermediately susceptible strains (including the MICs) and the therapy administered during the 14 days to analyze the influence of the antimicrobial susceptibility on the outcomes for these patients. Thus, we think that, with the information offered in this study, it is not possible to make firm conclusions about the influence of discordant initial therapy on the outcomes for patients with pneumococcal bacteremia due to strains not susceptible to b-lactams.