PENICILLIN-RESISTANT SYSTEMIC PNEUMOCOCCAL INFECTIONS IN CHILDREN - ARETROSPECTIVE CASE-CONTROL STUDY

Objective. To determine whether there are any risk factors that differ entiate children with systemic infections due to Streptococcus pneumon iae relatively or fully resistant (minimum inhibitory concentration > 0.1 mug/mL) to penicillin from those children with infections due to S pneumoniae susceptible to penicillin. Design. Retrospective case-cont rol study. Setting. A large children's hospital. Participants. Forty-t hree children with systemic penicillin-resistant S pneumoniae infectio ns identified at Texas Children's Hospital over the 51-month period fr om January 1989 through March 1993. Each case had one or two controls matched only for age and date of S. pneumoniae infection. Sixty-six co ntrols were selected from a group of 341 children with susceptible iso lates. Outcome measures. Variables compared included gender, race, dia gnosis, underlying conditions, past hospitalization, geographic area o f 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 ra nge 0.125 to 1.0 mug/mL) and six patients (15%) had fully resistant is olates (minimum inhibitory concentration range 2.0 to 8.0 pg/mL). Thir ty-three percent of the cases vs 36% of the controls had underlying co nditions. Seventy-one percent of the cases vs 39% of the controls had received antibiotics in the previous month. Compared with their matche d controls, the patients with penicillin-resistant systemic pneumococc al 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 sy stemic penicillin-resistant pneumococcal infection appears to have bee n the use of antibiotics within the month prior to their infection.