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Risk factors for penicillin-resistant systemic pneumococcal infections in children
J L Doone1, S L Klespies, C Sabella
1Department of Pediatrics, Children's Hospital Medical Center of Akron, Ohio, USA.
Insights
Children receiving antibiotics within one month are more likely to develop penicillin-resistant Streptococcus pneumoniae infections. This finding highlights a key risk factor for invasive pneumococcal disease caused by resistant strains.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Systemic infections caused by Streptococcus pneumoniae (pneumococcus) are a significant concern.
- Increasing antimicrobial resistance in S. pneumoniae necessitates identification of risk factors for resistant infections.
Purpose of the Study:
- To identify risk factors differentiating children with penicillin-resistant S. pneumoniae infections from those with penicillin-susceptible infections.
Main Methods:
- Retrospective case-controlled study of pediatric patients with S. pneumoniae bloodstream or cerebrospinal fluid infections.
- Comparison of patients with penicillin-susceptible versus penicillin-resistant isolates based on demographics, clinical factors, prior antibiotic use, and outcomes.
Main Results:
- Of 69 patients, 9 (13%) had penicillin-resistant S. pneumoniae infections.
- No significant differences were observed in age, race, gender, diagnosis, underlying conditions, treatment, or outcome between groups.
- Prior antibiotic exposure within one month was significantly higher in children with resistant infections (67%) compared to susceptible infections (4%, P < 0.0000097).
Conclusions:
- Recent antibiotic exposure is a significant risk factor for developing invasive penicillin-resistant S. pneumoniae infections in children.
- This finding underscores the importance of judicious antibiotic use in pediatric populations to mitigate the emergence of antimicrobial resistance.
Abstract:
The purpose of this study was to identify risk factors that may differentiate children who develop systemic infections with resistant strains of Streptococcus pneumoniae from those who develop penicillin-susceptible pneumococcal infections. A retrospective case-controlled study was 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 with those with penicillin-resistant infections in terms of age, race, gender, diagnosis, underlying conditions, antibiotic therapy within 1 month prior to systemic infection, treatment, and outcome. Sixty-nine patients with systemic pneumococcal infections were identified over the study period. Nine (13%) of these patients had infection with a penicillin-resistant isolate. Six of these patients were infected with a relatively resistant strain (MIC 0.1-1.0 microgram/mL) while three were infected with a fully resistant strain (MIC > or = 2.0 micrograms/mL). There was no difference between the two groups in terms of age, race, gender, underlying diagnosis, treatment, or outcome. Sixty-seven percent of the patients who developed a penicillin-resistant pneumococcal infection had received antibiotics in the month prior to systemic illness versus 4% of those infected with a penicillin-susceptible strain (P < 0.0000097). In conclusion, when compared with children who develop systemic infection with a penicillin-susceptible strain of S. pneumoniae, children who develop infection with a penicillin-resistant strain are significantly more likely to have received antibiotics within 1 month prior to their illness.