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August 1992

Antibiotic-Resistant Pneumococcal Disease in South African Children

Author Affiliations

From the Departments of Pediatrics (Dr Friedland) and Clinical Microbiology (Dr Klugman), Baragwanath Hospital, and the Emergent Pathogen Unit of the South African Institute for Medical Research (Dr Klugman), Johannesburg, South Africa. Dr Friedland is now with the Department of Pediatrics, Division of Infectious Disease, University of Texas Southwestern Medical Center, Dallas.

Am J Dis Child. 1992;146(8):920-923. doi:10.1001/archpedi.1992.02160200042023

• 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)