Penicillin-resistant pneumococcal infections in children

Area of Science:

• Pediatrics
• Infectious Diseases
• Microbiology

Background:

• Penicillin-resistant Streptococcus pneumoniae (PRSP) infections are a global concern.
• PRSP infections were rarely reported in Taiwan until this study period.
• A notable increase in PRSP infection rates was observed at Mackay Memorial Hospital between 1990 and 1995.

Purpose of the Study:

• To investigate the incidence and characteristics of systemic pneumococcal infections.
• To assess the prevalence of penicillin resistance in Streptococcus pneumoniae isolates.
• To evaluate the outcomes and mortality associated with PRSP infections, particularly meningitis.

Main Methods:

• Retrospective analysis of pediatric patients diagnosed with systemic pneumococcal infections from 1990 to 1995.
• Isolation and antimicrobial susceptibility testing of Streptococcus pneumoniae from clinical specimens (blood, CSF, joint fluid, pleural effusion).
• Clinical data review including patient demographics, underlying conditions, treatment, and outcomes.

Main Results:

• Twenty-four cases of systemic pneumococcal infections were identified.
• The rate of PRSP infections increased from <10% to 45% during the study period.
• Of 24 S. pneumoniae isolates, 70.8% were intermediately resistant and 29.2% were highly resistant to penicillin.
• Six patients died, including four of 12 with meningitis.
• High rates of PRSP and PRSP meningitis mortality were observed.

Conclusions:

• The incidence of penicillin-resistant Streptococcus pneumoniae infections and associated mortality, especially for meningitis, is high in Taiwan.
• The oxacillin disc diffusion test is crucial for early detection.
• Prompt diagnosis and appropriate antibiotic therapy are essential to reduce mortality and morbidity.