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Invasive pneumococcal infection in a community hospital, 1993 to 1995. Characteristics of resistant strains
1Department of Pediatrics and Emergency, George Washington University, Washington, DC, USA.
Insights
Penicillin-resistant Streptococcus pneumoniae infections are common. Recent antibiotic use and low neutrophil counts can help identify these resistant strains in children.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Microbiology
- Antimicrobial Resistance
Background:
- Invasive Streptococcus pneumoniae infections pose a significant public health concern.
- The emergence of penicillin-resistant pneumococcal (PRP) strains necessitates understanding predictive factors for early identification.
- Distinguishing PRP from penicillin-sensitive strains at emergency care presentation is crucial for appropriate treatment.
Purpose of the Study:
- To review invasive Streptococcus pneumoniae infections in children at a single institution.
- To identify clinical and laboratory factors differentiating penicillin-resistant from penicillin-sensitive pneumococcal strains upon emergency care presentation.
Main Methods:
- Retrospective review of consecutive pediatric cases with positive blood and cerebrospinal fluid cultures for S. pneumoniae.
- Analysis of patient demographics, clinical diagnoses, antibiotic exposure, white blood cell counts, and absolute neutrophil counts.
- Statistical analysis including regression modeling to identify predictive factors for penicillin resistance.
Main Results:
- Twenty-one percent of invasive S. pneumoniae infections were penicillin-resistant; 4% were highly resistant.
- Penicillin-resistant pneumococcal strains were significantly associated with recent or concurrent antibiotic therapy (P = .002).
- Children with PRP strains exhibited lower mean white blood cell (14.9 x 10(9)/L) and absolute neutrophil counts (7250) compared to sensitive strains (22.8 x 10(9)/L and 12700, respectively).
- A combination of antibiotic use and absolute neutrophil count predicted 63% of resistant and 92% of sensitive strains (P = .001).
Conclusions:
- A substantial proportion of invasive pneumococcal infections in this cohort were caused by penicillin-resistant strains.
- Recent antibiotic therapy and a low absolute neutrophil count are key indicators associated with penicillin-resistant pneumococcal strains in children.
- Further surveillance and clinical vigilance are warranted to manage the rising threat of antimicrobial resistance in Streptococcus pneumoniae infections.
Objectives:
To review all cases of invasive Streptococcus pneumoniae infection at a single institution and to identify factors that may allow distinguishing between penicillin-resistant pneumococcal (PRP) and penicillin-sensitive pneumococcal strains at presentation for emergency care.
Patients And Methods:
Consecutive patient series of all children with positive blood and cerebrospinal fluid cultures for S pneumoniae from January 1993 to April 1995 at a general community hospital.
Results:
Fifty-three patients with invasive S pneumoniae infections were identified; 21% of the infections were resistant to penicillin, 9% were resistant to multiple antibiotics, and 4% were highly resistant to penicillin (minimum inhibitory concentration, > 2 mg/L). At admission, a diagnosis of meningitis or sepsis was made in 14 patients; of these, 8 cerebrospinal fluid cultures yielded S pneumoniae, and 5 were PRP (P < .001). Significant differences between sensitive and resistant strains were not found for sex, age, race, ill household contacts, or physician type. Five of 11 children with PRP strains were either receiving antibiotics concurrently or in the prior 30 days compared with 5 of 42 children with penicillin-sensitive pneumococcal strains (P = .002). Children with PRP strains had a lower mean white blood cell count (14.9 x 10(9)/L vs 22.8 x 10(9)/L, P = .008) than children with penicillin-sensitive pneumococcal strains, owing to a lower mean absolute neutrophil count (7250 vs 12700, P = .006). Children with lower white blood cell and absolute neutrophil counts did not, however, differ in other objective measures. Regression analysis showed that the combination of current or prior antibiotic use and an absolute neutrophil count predicted 63% of the resistant strains and 92% of the sensitive strains (P = .001).
Conclusions:
A high proportion of S pneumoniae infections were caused by strains that were resistant to penicillin. We discuss factors that are associated with resistance in this population. The PRP strains were associated with recent antibiotic therapy and a low absolute neutrophil count. Further surveillance is warranted by these findings.