Clinical characteristics and outcome of children with pneumonia attributable to penicillin-susceptible and penicillin-nonsusceptible Streptococcus pneumoniae

Objective. To compare the clinical characteristics, treatment, and outcome of pediatric patients with pneumonia attributable to isolates of Streptococ cus pneumoniae that were either susceptible or nonsusceptible to penicillin . Design. Multicenter, retrospective study. Setting. Eight children's hospitals in the United States. Participants. Two hundred fifty-four children with pneumococcal pneumonia i dentified from patients enrolled in the United States Pediatric Multicenter Pneumococcal Surveillance Study during the 3-year period from September 1, 1993 to August 31, 1996. Outcome Measures. Demographic and clinical variables including necessity fo r and duration of hospitalization, frequency of chest tube placement, antim icrobial therapy, susceptibility of isolates, and clinical outcome. Results. There were 257 episodes of pneumococcal pneumonia that occurred in 254 patients. Of the 257 isolates, 22 (9%) were intermediate and 14 (6%) w ere resistant to penicillin; 7 (3%) were intermediate to ceftriaxone and 5 (2%) were resistant to ceftriaxone. There were no differences noted in the clinical presentation of the patients with susceptible versus nonsusceptibl e isolates. Twenty-nine percent of the patients had a pleural effusion. The 189 (74%) hospitalized patients were more likely to have an underlying ill ness, multiple lung lobe involvement, and the presence of a pleural effusio n than nonhospitalized patients. Fifty-two of 72 hospitalized patients with pleural effusions had a chest tube placed, and 27 subsequently underwent a decortication drainage procedure. Eighty percent of the patients treated a s outpatients and 48% of the inpatients received a parenteral second or thi rd generation cephalosporin followed by a course of an oral antimicrobial a gent. Two hundred forty-eight of the patients (97.6%) had a good response t o therapy. Six patients died; however, only 1 of the deaths was related to the pneumococcal infection. Conclusion. The clinical presentation and outcome of therapy did not differ significantly between patients with penicillin-susceptible versus those wi th nonsusceptible isolates of S pneumoniae. Hospitalized patients were more likely to have underlying illnesses, multiple lobe involvement, and the pr esence of pleural effusions than patients who did not require hospitalizati on. In otherwise normal patients with pneumonia attributable to penicillin- resistant pneumococcal isolates, therapy with standard beta-lactam agents i s effective.