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Antibiotic-resistant pneumococcal disease in South African children
1Department of Pediatrics, Baragwanath Hospital, Johannesburg, South Africa.
Insights
Antibiotic resistance in Streptococcus pneumoniae is alarmingly high in South Africa, with penicillin-resistant strains causing similar illness severity to susceptible strains. This highlights a growing public health concern for pneumococcal disease.
Area of Science:
- Microbiology
- Infectious Diseases
- Clinical Medicine
Background:
- Antibiotic resistance in Streptococcus pneumoniae is a significant global health challenge.
- Penicillin resistance in pneumococcal infections has been increasing, necessitating updated treatment guidelines.
- Understanding the clinical implications of resistant pneumococcal strains is crucial for patient management.
Purpose of the Study:
- To determine the incidence of antibiotic-resistant pneumococcal disease.
- To compare the clinical presentation and outcomes of penicillin-resistant versus penicillin-susceptible pneumococcal infections.
Main Methods:
- A patient series design was employed in a general community hospital setting.
- Eighty-three children with penicillin-resistant pneumococcal bacteremia or meningitis and 124 with penicillin-susceptible infections were analyzed.
- Data were collected from consecutive patients admitted between 1989 and 1991.
Main Results:
- Forty percent of community-acquired and 95% of hospital-acquired pneumococcal isolates were penicillin-resistant.
- Resistance to chloramphenicol, tetracycline, and erythromycin was observed in 9%, 12%, and 4% of isolates, respectively.
- The proportion of penicillin-resistant pneumococci with elevated cefotaxime minimum inhibitory concentrations increased significantly from 1986 to this study.
Conclusions:
- Streptococcus pneumoniae resistance to beta-lactam antibiotics has alarmingly increased in South Africa.
- Penicillin-resistant and penicillin-susceptible pneumococcal infections present with a similar spectrum of illness.
- The findings underscore the urgent need for surveillance and updated therapeutic strategies for pneumococcal infections.
Objective:
To determine the incidence of antibiotic-resistant pneumococcal disease and to compare the presentation and outcome of penicillin-resistant infections with penicillin-susceptible infections.
Design:
Patient series.
Setting:
General community hospital.
Patients:
Eighty-three children with penicillin-resistant pneumococcal bacteremia or meningitis and 124 children with penicillin-susceptible pneumococcal bacteremia or meningitis.
Selection Procedures:
Consecutive patients admitted between 1989 and 1991.
Interventions:
None.
Measurements And Results:
Forty percent of community-acquired isolates and 95% of hospital-acquired isolates were resistant to penicillin. Eighty-three (82%) of 101 penicillin-resistant infections were community acquired. Resistance to chloramphenicol, tetracycline, and erythromycin occurred in 9%, 12%, and 4% of all isolates, respectively. The proportion of penicillin-resistant pneumococci with cefotaxime minimum inhibitory concentrations greater than or equal to 0.5 micrograms/mL increased from 0% in a 1986 study to 21.5% in this study. The sites of infection, underlying diseases, and mortality of patients with penicillin-resistant infections outside the central nervous system did not differ significantly from those of penicillin-susceptible infections.
Conclusions:
The resistance of Streptococcus pneumoniae to beta-lactam antibiotics has increased alarmingly in South Africa. Penicillin-resistant and penicillin-susceptible pneumococcal infections cause a similar spectrum of illness.