Related Experiment Videos
Three-year multicenter surveillance of systemic pneumococcal infections in children
S L Kaplan1, E O Mason, W J Barson
1Pediatric Infectious Disease Section, Baylor College of Medicine, Houston, TX 77030, USA.
Insights
Antibiotic resistance in Streptococcus pneumoniae is increasing in children with systemic infections, but mortality has not risen. Continued monitoring of antibiotic susceptibility is crucial for treatment recommendations.
Area of Science:
- Pediatric Infectious Diseases
- Antimicrobial Resistance
- Clinical Microbiology
Background:
- Systemic infections caused by Streptococcus pneumoniae are a significant concern in pediatric populations.
- Tracking antibiotic susceptibility patterns is essential for effective treatment strategies.
Purpose of the Study:
- To monitor the antibiotic susceptibility of Streptococcus pneumoniae isolates from children with systemic infections.
- To evaluate the treatment outcomes in relation to antibiotic resistance.
Main Methods:
- Prospective surveillance study conducted over three years (September 1993 - August 1996).
- Involved culture-proven systemic pneumococcal infections in infants and children across eight US children's hospitals.
- Monitored antimicrobial susceptibility to penicillin and ceftriaxone.
Main Results:
- A total of 1291 episodes of systemic pneumococcal infection were identified in 1255 children.
- Nonsusceptibility to penicillin and ceftriaxone among isolates increased annually, nearly doubling over the study period.
- No significant difference in mortality was observed between patients with susceptible and nonsusceptible isolates.
Conclusions:
- The yearly increase in pneumococcal isolate nonsusceptibility to penicillin and ceftriaxone highlights a growing resistance trend.
- Despite rising resistance, antibiotic resistance has not been linked to increased mortality in this pediatric cohort.
- Ongoing surveillance of antibiotic susceptibility and treatment outcomes is vital for updating clinical practice guidelines.
Objective:
To track antibiotic susceptibility of Streptococcus pneumoniae isolates obtained from children with systemic infections and determine outcome of treatment.
Design:
A 3-year (September 1993 through August 1996) prospective surveillance study of all invasive pneumococcal infections in children.
Patients:
Infants and children cared for at eight children's hospitals in the United States with culture-proven systemic pneumococcal infection.
Results:
One thousand two hundred ninety-one episodes of systemic pneumococcal infection were identified in 1255 children. An underlying illness was present in the children for 27% of the episodes. The proportion of isolates that were nonsusceptible to penicillin or ceftriaxone increased annually and nearly doubled throughout the 3-year period; for the last year the percentages of isolates nonsusceptible to penicillin and ceftriaxone were 21% and 9.3%, respectively. There was no difference in mortality between patients with penicillin-susceptible or nonsusceptible isolates. Only 1 of 742 patients with bacteremia had a repeat blood culture that was positive > 1 day after therapy was started. All 24 normal children with bacteremia attributable to isolates resistant to penicillin had resolution of their infection; the most common treatment regimen was a single dose of ceftriaxone followed by an oral antibiotic.
Conclusions:
The percentage of pneumococcal isolates nonsusceptible to penicillin and ceftriaxone increased yearly among strains recovered from children with systemic infection. Because empiric antibiotic therapy already has changed for suspected pneumococcal infections, antibiotic resistance has not been associated with increased mortality. Careful monitoring of antibiotic susceptibility and outcome of therapy is necessary to continually reassess current recommendations for treatment.