Pneumococcal infections in children after transplantation

Bacterial infections in recipients of bone marrow and solid-organ transplan ts remain a major cause of morbidity and death. The cases of 42 children wh o had undergone transplantation and developed an infection with Streptococc us pneumoniae were retrospectively reviewed. Thirty-four patients had 1 epi sode of infection, whereas 7 had 2 episodes and 1 had 3 episodes of infecti on. Solid-organ recipients were more likely to have recurrent invasive dise ase (P<.02). A total of 31 (74%) of 42 patients were on immunosuppressive t herapy, and 74% had been on antimicrobial therapy within 30 days before dia gnosis of S. pneumoniae infection. Only 33% of eligible patients had receiv ed a pneumococcal vaccine. Twenty-six percent of isolates recovered were no t susceptible to penicillin, and 18% were not susceptible to ceftriaxone. T wo patients experienced infection-related deaths; one of these had a penici llin-nonsusceptible isolate. The antimicrobial susceptibilities and outcome of infections with S. pneumoniae in patients who have undergone transplant ation are similar to those in the general pediatric population.