RISK-FACTORS FOR PENICILLIN-RESISTANT SYSTEMIC PNEUMOCOCCAL INFECTIONS IN CHILDREN

The purpose of this study was to identify risk factors that may differ entiate children who develop systemic infections with resistant strain s of Streptococcus pneumoniae from those who develop penicillin-suscep tible pneumococcal infections. A retrospective case-controlled study w as performed of all patients with positive blood and/or cerebrospinal fluid isolates for S. pneumoniae over a 13 1/2-month period. Patients with penicillin-susceptible strains of S. pneumoniae were compared wit h those with penicillin-resistant infections in terms of age, race, ge nder, diagnosis, underlying conditions, antibiotic therapy within 1 mo nth prior to systemic infection, treatment, and outcome. Sixty-nine pa tients with systemic pneumococcal infections were identified over the study period. Nine (13%) of these patients had infection with a penici llin-resistant isolate. Six of these patients were infected with a rel atively resistant strain (MIG 0.1-1.0 mu g/mL) while three were infect ed with a fully resistant strain (MIC greater than or equal to 2.0 mu g/mL). There was no difference between the two groups in terms of age, race, gender, underlying diagnosis, treatment, or outcome. Sixty-seve n percent of the patients who developed a penicillin-resistant pneumoc occal infection had received antibiotics in the month prior to systemi c illness versus 4% of those infected with a penicillin-susceptible st rain (P<0.0000097). In conclusion, when compared with children who dev elop systemic infection with a penicillin-susceptible strain of S. pne umoniae, children who develop infection with a penicillin-resistant st rain are significantly more likely to have received antibiotics within 1 month prior to their illness.