PEDIATRICS Vol. 92 No. 6 December 1993, pp. 761-767
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Penicillin-Resistant Systemic Pneumococcal Infections in Children: A Retrospective Case-Control Study

Tina Q. Tan MD1, Edward O. Mason Jr PhD2, and Sheldon L. Kaplan MD1

1 From the Infectious Diseases Section, Department of Pediatrics, Texas Children's Hospital, Houston
2 From the Infectious Diseases Section, Departments of Pediatrics and Microbiology and Immunology, Baylor College of Medicine and the Infectious Disease Laboratory, Texas Children's Hospital, Houston

Objective. To determine whether there are any risk factors that differentiate children with systemic infections due to Streptococcus pneumoniae relatively or fully resistant (minimum inhibitory concentration >0.1 µg/mL) to penicillin from those children with infections due to S pneumoniae susceptible to penicillin.

Design. Retrospective case-control study.

Setting. A large children's hospital.

Participants. Forty-three children with systemic penicillin-resistant S pneumoniae infections identified at Texas Children's Hospital over the 51-month period from January 1989 through March 1993. Each case had one or two controls matched only for age and date of S. pneumoniae infection. Sixty-six controls were selected from a group of 341 children with susceptible isolates.

Outcome measures. Variables compared included gender, race, diagnosis, underlying conditions, past hospitalization, geographic area of residence, antibiotic use in past month, amoxicillin-clavulanic acid use in past month, and outcome.

Results. Thirty-seven patients (86%) had relatively resistant isolates (minimum inhibitory concentration range 0.125 to 1.0 µg/mL) and six patients (15%) had fully resistant isolates (minimum inhibitory concentration range 2.0 to 8.0 µg/mL). Thirty-three percent of the cases vs 36% of the controls had underlying conditions. Seventy-one percent of the cases vs 39% of the controls had received antibiotics in the previous month. Compared with their matched controls, the patients with penicillin-resistant systemic pneumococcal infections were more likely (P = .02) to have received a course of antibiotics within the month prior to their infection.

Conclusion. The only identified associated risk factor in children who developed a systemic penicillin-resistant pneumococcal infection appears to have been the use of antibiotics within the month prior to their infection.

Key Words: penicillin • Streptococcus pneumoniae

Submitted on April 7, 1993
Accepted on May 19, 1993




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