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PEDIATRICS Vol. 102 No. 6 December 1998, pp. 1369-1375

Clinical Characteristics and Outcome of Children With Pneumonia Attributable to Penicillin-susceptible and Penicillin-nonsusceptible Streptococcus pneumoniae

Received Dec 17, 1997; accepted May 13, 1998.

Tina Q. Tan*, Edward O. Mason JrDagger , William J. Barson§, Ellen R. Waldparallel , Gordon E. Schutze, John S. Bradley#, Moshe Arditi**, Laurence B. GivnerDagger Dagger , Ram Yogev*, Kwang Sik Kim**, and Sheldon L. KaplanDagger

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

Objective.  To compare the clinical characteristics, treatment, and outcome of pediatric patients with pneumonia attributable to isolates of Streptococcus pneumoniae that were either susceptible or nonsusceptible to penicillin.

Design.  Multicenter, retrospective study.

Setting.  Eight children's hospitals in the United States.

Participants.  Two hundred fifty-four children with pneumococcal pneumonia identified from patients enrolled in the United States Pediatric Multicenter Pneumococcal Surveillance Study during the 3-year period from September 1, 1993 to August 31, 1996.

Outcome Measures.  Demographic and clinical variables including necessity for and duration of hospitalization, frequency of chest tube placement, antimicrobial therapy, susceptibility of isolates, and clinical outcome.

Results.  There were 257 episodes of pneumococcal pneumonia that occurred in 254 patients. Of the 257 isolates, 22 (9%) were intermediate and 14 (6%) were resistant to penicillin; 7 (3%) were intermediate to ceftriaxone and 5 (2%) were resistant to ceftriaxone. There were no differences noted in the clinical presentation of the patients with susceptible versus nonsusceptible isolates. Twenty-nine percent of the patients had a pleural effusion. The 189 (74%) hospitalized patients were more likely to have an underlying illness, multiple lung lobe involvement, and the presence of a pleural effusion than nonhospitalized patients. Fifty-two of 72 hospitalized patients with pleural effusions had a chest tube placed, and 27 subsequently underwent a decortication drainage procedure. Eighty percent of the patients treated as outpatients and 48% of the inpatients received a parenteral second or third generation cephalosporin followed by a course of an oral antimicrobial agent. Two hundred forty-eight of the patients (97.6%) had a good response to therapy. Six patients died; however, only 1 of the deaths was related to the pneumococcal infection.

Conclusion.  The clinical presentation and outcome of therapy did not differ significantly between patients with penicillin-susceptible versus those with nonsusceptible isolates of S pneumoniae. Hospitalized patients were more likely to have underlying illnesses, multiple lobe involvement, and the presence of pleural effusions than patients who did not require hospitalization. In otherwise normal patients with pneumonia attributable to penicillin-resistant pneumococcal isolates, therapy with standard beta -lactam agents is effective.  Key words:  pediatrics, pneumococcal pneumonia, penicillin-resistance.




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