PNEUMOCOCCAL BACTEREMIA AND SEPSIS IN CHI LDREN - A MULTICENTER STUDYIN FRANCE

Ninety-nine cases of pneumococcal bacteremia, recorded during year 199 3 from 22 french pediatric hospitals, were retrospectively analysed. T he incidence was estimated 0,47-4,3 p. 1000 blood cultures. Mean age w as 3,5 years (range 0 days - 17,2 years); 56% were 3 months to 3 years old. Eleven children had immunosuppression. Only one patient was immu nized with the 23-valent pneumococcal polysaccharide vaccine (splenect omy). A focus of infection was identified in 60 patients : among them, 16 had otitis media or sinusitis, 27 had a bronchopulmonary infection and 14 had meningitis 2 of which were diagnosed in a second time afte r admission. Among all isolates, 24,5% had reduced susceptibility to p enicillin (MIC > 0,1 mg/l) and 14,3 % were resistant (MIC > 1 mg/l). R educed susceptibility to penicillin was significantly higher in the re gion of Paris, in immunosuppressed patients and in case of previous tr eatment with a beta-lactam antibiotic. Resistance to other antibiotics was also tested : macrolides = 33,8%, streptogramines = 0,8%, trimeth oprim-sulfamethoxazole = 27,6%, chloramphenicol = 28% and vancomycin = 0%. No difference in susceptibility was found with regard to the clin ical presentation (fever of unknown origin, identified focus of infect ion). The six predominant serotypes (62% of the isolates) were, by dec reasing frequency : 23, 14, 9, 6, 4, 19 and 1. Serotype 23 was linked to a high degree of resistance (9 isolates/14). All but 3 patients rec overed uneventfully, despite inadequate therapy for some of them. Thre e patients died; all had acute or relapsing leukemia.