Clinical implications of penicillin and ceftriaxone resistance among children with pneumococcal bacteremia

Objectives. To determine whether reduced penicillin or ceftriaxone suscepti bility affects clinical presentation and outcome in children with pneumococ cal bacteremia, Design, Retrospective review of patients with Streptococcus pneumoniae bact eremia, Results, We reviewed 922 cases of pneumococcal bacteremia, Of 744 isolates with known penicillin (PCN) susceptibilities 56 were PCN-nonsusceptible. Th e majority displayed intermediate resistance; 14 of 730 isolates with known ceftriaxone (CTX) susceptibilities were CTX-nonsusceptible. Neither the PC N- nor the CTX-nonsusceptible cohort displayed a difference from its suscep tible counterpart in temperature, respiratory rate or white blood cell coun t on initial patient evaluation, although trend suggested they were more of ten admitted at the initial visit. At follow-up only children treated initi ally with antibiotic were evaluated, Children with PCN-nonsusceptible isola tes were no more likely to be febrile than those with PCN-susceptible isola tes (28% vs, 25%, P = 0.61) and were no more likely to have a positive repe at blood culture (0% vs. 1%, P = 0.59) or a new focal infection (10% vs. 6% , P = 0.79). Data concerning CTX-nonsusceptible organisms were limited by t he low number of such isolates. Although patients with CTX-nonsusceptible p neumococci were more likely to be febrile at follow-up than those with CTX- susceptible organisms (67% vs. 24%, P = 0.04), we were unable to demonstrat e a significant difference for other endpoints, Conclusions, Reduced antibiotic susceptibility does not alter the clinical presentation of pneumococcal bacteremia, With current practice intermediate resistance to PCN is of little clinical significance in nonmeningitic syst emic pneumococcal infections.