Original articleClinical Outcome of Invasive Infections in Children Caused by Highly Penicillin-Resistant Streptococcus pneumoniae Compared with Infections Caused by Penicillin-Susceptible Strains
Introduction
Streptococcus pneumoniae (S. pneumoniae) is a leading cause of infectious disease-associated morbidity and mortality worldwide. Local and systemic infections caused by S. pneumoniae include otitis media and sinusitis as less serious but very common illnesses, as well as bacteremia, pneumonia, sepsis, and meningitis 1, 2, all serious bacterial infections. Many diseases are potentially vaccine-preventable 3, 4, 5.
Drug-resistant strains of S. pneumoniae were relatively uncommon in Mexico through 1993 6, 7, 8, 9, 10, 11, and penicillin was selected as the drug-of-choice for the empiric treatment of severe pneumococcal infections for more than 50 years. The presence of strains with diminished susceptibility to penicillin and other agents is now recognized worldwide, and as this problem continues to increase in incidence, selection for the empirical treatment of these infections may need to be changed.
It is accepted that penicillin therapy is inappropriate for the treatment of penicillin-resistant pneumococcal meningitis 12, 13, 14, 15. However, there is little evidence to suggest that penicillin-resistant S. pneumoniae infections outside the CNS respond poorly to therapy with penicillin or an equivalent beta lactam 16, 17, 18, 19, 20, 21. Serum concentrations of penicillin or other beta lactams much greater than minimal inhibitory concentrations (MICs) for most penicillin-resistant strains are achieved with standard dosages, relevant in nonmeningeal infections.
In this report, we correlate the clinical course of invasive pneumococcal infections with a number of factors that includes site and severity of infection, underlying health of the patient, adequacy of antimicrobial therapy, and comparison of the clinical outcome of infections other than meningitis that are caused by highly penicillin-resistant or penicillin-susceptible S. pneumoniae.
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Methods
From March 1995 to June 1999, we undertook a 4-year prospective study at the Hospital Infantil de Mexico Federico Gómez, a teaching and referral hospital serving a population of more than 1,000,000 inhabitants in Mexico City. This was a nonintervention study in which children with invasive pneumococcal infection were followed prospectively until resolution of clinical signs and symptoms. Patients were included in the protocol as soon as culture results of blood, pleural fluid, and other
Isolates
During the study period, all S. pneumoniae isolated from normally sterile body fluids of children with invasive disease were collected prospectively and stored frozen (−70°C). Strains of S. pneumoniae were identified by standard methods (22), i.e., susceptibility to optochin and bile solubility.
Serotyping
The swelling test with omniserum pools and type/group-specific antisera from Statens Seruminstitut, Copenhagen, Denmark was used.
Antimicrobial susceptibility
All strains were routinely screened for susceptibility to penicillin with
Results
Of all cases of culture-proven invasive S. pneumoniae disease, 28 (57%) were male and 21 (43%), female. Patients' ages ranged from 1 month to 11 years (median age, 16 months); 35 (71%) were ≤2 years of age.
The sources of the specimens from which S. pneumoniae were isolated and comparison of clinical features in 49 children with severe invasive pneumococcal infections who were divided in two groups according to penicillin susceptibility are presented in Table 1.
Thirty-seven (37 of 49, 75%)
Discussion
The prevalence of antimicrobial resistance of Streptococcus pneumoniae strains responsible for invasive infections in children at Hospital Infantil de Mexico Federico Gómez is very high, and has increased over the last 3 years, similar to other reports 17, 21, 25, 26, 27.
At our hospital, approximately 30% of patients admitted to having an underlying disease, mainly dealing with hemato-oncologic processes, immunosuppression, and malnutrition. Some of these patients acquired the pneumococcal
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Host and microbiologic factors associated with mortality in Taiwanese children with invasive pneumococcal diseases, 2001 to 2006
2009, Diagnostic Microbiology and Infectious DiseaseCitation Excerpt :The presence of underlying chronic illnesses predicting an unfavorable outcome has been well documented in both adults and pediatric patients (Alanee et al., 2007; Gomez-Barreto et al., 2000). The association of IPD mortality and penicillin resistance, however, was not consistently observed by other investigators and remained controversial (Deeks et al., 1999; Gomez-Barreto et al., 2000; Laurichesse et al., 2001). A metaanalysis of 10 studies involving 3430 adult patients with pneumococcal pneumonia indicated that penicillin resistance is associated with a higher short-term mortality rate than is penicillin susceptibility (Tleyjeh et al., 2006).
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2001, Archives de PediatrieRate of drug-resistant Streptococcus pneumoniae in children with invasive pneumococcal disease: a decade review
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