PENICILLIN-RESISTANT AND CEPHALOSPORIN-RESISTANT STRAINS OF STREPTOCOCCUS-PNEUMONIAE CAUSING SEPSIS AND MENINGITIS IN CHILDREN WITH SICKLE-CELL DISEASE

Objective: We investigated the possibility that antimicrobial-resistan t pneumococci were causing invasive disease in children with sickle-ce ll disease (SCD), Study design: Records of all children with SCD obser ved at the Mid-South Sickle Cell Center (MSSCC) at LeBonheur Children' s Medical Center were reviewed from January 1990 to June 1994, Childre n with SCD and pneumococcal sepsis were identified, The Streptococcus pneumoniae isolates from these children were examined for serotype and antimicrobial susceptibilities. Two additional children not observed in the MSSCC had pneumococcal sepsis caused by penicillin-resistant is olates and were also included, Results: Antimicrobial susceptibility t esting of the six penicillin-resistant isolates revealed that four wer e resistant to trimethoprim-sulfamethoxazole, two to erythromycin, and one to clindamycin, The two isolates that were resistant to ceftriaxo ne also were multiply resistant, From the MSSCC, 26 children had pneum ococcal sepsis during the 4 1/2-year period studied. Five of these chi ldren (19%) died, Four (15%), including one who died, were infected wi th penicillin-resistant strains. Conclusion: Pneumococcal sepsis, meni ngitis, and infections of other foci in children with SCD may be cause d by S, pneumoniae that is resistant to one or more antimicrobial agen ts, including penicillin, The addition of vancomycin to the antibiotic s currently used for initial management should be considered in areas where the antibiotic resistance of S, pneumoniae is prevalent.