COMPLICATED PARAPNEUMONIC EFFUSIONS IN CHILDREN CAUSED BY PENICILLIN-NONSUSCEPTIBLE STREPTOCOCCUS-PNEUMONIAE

Objective. To describe the clinical characteristics of complicated par apneumonic effusions (CPE) in children caused by Streptococcus pneumon iae nonsusceptible to penicillin (PCN-N) and compare their clinical ou tcome with CPE caused by penicillin-susceptible (PCN-S) organisms. Des ign. Children with parapneumonic effusions were identified retrospecti vely between July 1992 and Tune 1996. Charts of patients with CPE were reviewed for data obtained at the time of hospital admission. In addi tion, outpatient charts and/or the families of children with CPE cause d by PCN-N S pneumoniae were reviewed to identify specific risk factor s associated with PCN-N organisms. Results. Sixty-four cases of CPE we re identified during the 4-year period. In 26 cases a bacterial pathog en was recovered, with S pneumoniae accounting for 23 of these isolate s (88%). Of the 23 S pneumoniae cases, 17 were PCN-S and 6 cases were nonsusceptible. Complicated parapneumonic effusions caused by PCN-N S pneumoniae occurred in significantly younger patients than CPE that we re PCN-S (2.1 years vs 7.9 years). Nonsusceptible effusions also had a higher incidence of bacteremia than PCN-S effusions (100% vs 29%). Th ere were no significant differences between the two groups for duratio n of chest tube drainage, febrile days, oxygen use, and hospital stay. Conclusion. CPE caused by PCN-N S pneumoniae is associated with a you nger age and higher rate of bacteremia than CPE caused by PCN-S strain s. However, there were no significant differences in outcome measures between patients infected with susceptible or nonsusceptible organisms .