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PEDIATRICS Vol. 102 No. 3 September 1998, pp. 538-545

Three-Year Multicenter Surveillance of Systemic Pneumococcal Infections in Children

Received Oct 24, 1997; accepted Feb 27, 1998.

Sheldon L. Kaplan*, Edward O. Mason Jr*, William J. BarsonDagger , Ellen R. Wald§, Moshe Arditiparallel , Tina Q. Tan, Gordon E. Schutze#, John S. Bradley**, Laurence B. GivnerDagger Dagger , Kwang Sik Kimparallel , and Ram Yogev

From the * Pediatric Infectious Disease Sections of the Baylor College of Medicine and Texas Children's Hospital, Houston, Texas; the Dagger  Ohio State University College of Medicine, Columbus, Ohio; the § University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; the parallel  University of Southern California School of Medicine, Los Angeles, California; the  Northwestern University Medical School, Chicago, Illinois; the # University of Arkansas for Medical Sciences, Little Rock, Arkansas; the ** Children's Hospital San Diego and the University of California-San Diego School of Medicine, San Diego, California; and the Dagger Dagger  Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina.

Objective.  To track antibiotic susceptibility of Streptococcus pneumoniae isolates obtained from children with systemic infections and determine outcome of treatment.

Design.  A 3-year (September 1993 through August 1996) prospective surveillance study of all invasive pneumococcal infections in children.

Patients.  Infants and children cared for at eight children's hospitals in the United States with culture-proven systemic pneumococcal infection.

Results.  One thousand two hundred ninety-one episodes of systemic pneumococcal infection were identified in 1255 children. An underlying illness was present in the children for 27% of the episodes. The proportion of isolates that were nonsusceptible to penicillin or ceftriaxone increased annually and nearly doubled throughout the 3-year period; for the last year the percentages of isolates nonsusceptible to penicillin and ceftriaxone were 21% and 9.3%, respectively. There was no difference in mortality between patients with penicillin-susceptible or nonsusceptible isolates. Only 1 of 742 patients with bacteremia had a repeat blood culture that was positive >1 day after therapy was started. All 24 normal children with bacteremia attributable to isolates resistant to penicillin had resolution of their infection; the most common treatment regimen was a single dose of ceftriaxone followed by an oral antibiotic.

Conclusions.  The percentage of pneumococcal isolates nonsusceptible to penicillin and ceftriaxone increased yearly among strains recovered from children with systemic infection. Because empiric antibiotic therapy already has changed for suspected pneumococcal infections, antibiotic resistance has not been associated with increased mortality. Careful monitoring of antibiotic susceptibility and outcome of therapy is necessary to continually reassess current recommendations for treatment.  Key words:  Streptococcus pneumoniae, antibiotic resistance, outcome.




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