Antibiotic-Resistant Pneumococcal Disease in South African Children

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Abstract
• 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. Intervention. —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 μg/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 β-lactam antibiotics has increased alarmingly in South Africa. Penicillin-resistant and penicillin-susceptible pneumococcal infections cause a similar spectrum of illness. (AJDC. 1992;146:920-923)