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PEDIATRICS Vol. 103 No. 2 February 1999, pp. 409-413

Risk Factors and Course of Illness Among Children With Invasive Penicillin-resistant Streptococcus pneumoniae

Received Mar 23, 1998; accepted Aug 13, 1998.

Shelley L. Deeks*, Dagger , Rosario Palacio§, Raúl Ruvinskyparallel , Daniel A. Kertesz*, Maria Hortal§, Alicia Rossi, John S. Spika*, José Luis Di Fabio#, and The Streptococcus pneumoniae Working Group

From the * Bureau of Infectious Diseases, Laboratory Centre for Disease Control, Health Canada, Ottawa, Canada; the Dagger  Field Epidemiology Training Program, Laboratory Centre for Disease Control, Health Canada, Ottawa, Canada; the § Central Public Health Laboratory, Montevideo, Uruguay; the parallel  Ministerio de Salud Pública de la Nación, Acute Respiratory Infection Program (ARI) for Argentina, Buenos Aires, Argentina; the  Instituto Nacional de Microbiologiá Dr C. Malbrán, Bacteriology Department, Buenos Aires, Argentina; and the # Pan American Health Organization, Washington, DC.

Objectives.  To assess differences in risk factors, clinical presentation, and course of illness between children infected with penicillin-sensitive and drug-resistant Streptococcus pneumoniae (DRSP).

Design.  A retrospective cohort study conducted in Uruguay and Argentina using information from a hospital-based surveillance system. Hospitalized children 5 years of age and younger who had S pneumoniae isolated from a normally sterile site between June 1993 and October 1996 were eligible. Hospital records were linked with surveillance data. Both stratified univariate analysis and logistic regression was completed.

Results.  Of the 380 children eligible for the study, 274 records (72%) were available for review. Ninety-nine children (36%) had DRSP; 46 showed intermediate susceptibility (minimum inhibitory concentration, 0.12-1.0 µg/mL) and 53 showed high-level resistance (minimum inhibitory concentration >= 2.0 µg/mL). Children with meningitis were less likely to have DRSP than those with other forms of invasive disease (relative risk = 0.5; 95% confidence interval [CI], 0.2-0.9). Risk factors associated with DRSP were use of penicillin or ampicillin in the 3 months before illness (odds ratio = 2.9; 95% CI, 1.5-5.7) and possession of private medical coverage (odds ratio = 2.4; 95% CI, 1.2-5.0). Response to therapy, including response to penicillin or ampicillin among children with nonmeningeal invasive disease, course of illness, and clinical outcome did not differ significantly between children infected with penicillin-susceptible or penicillin-resistant isolates.

Conclusion.  In this study, previous use of penicillin or ampicillin and private medical coverage were associated with having DRSP. Children with nonmeningeal invasive disease responded equally well to penicillin regardless of the penicillin susceptibility of their pneumococcal isolate.  Key words:  pneumococcal disease, penicillin resistance, penicillin susceptibility, Streptococcus pneumoniae.




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