Antibiotic-resistant pneumococcal disease in South African children.
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.


METHODS
Patient series.


METHODS
General community hospital.


METHODS
Eighty-three children with penicillin-resistant pneumococcal bacteremia or meningitis and 124 children with penicillin-susceptible pneumococcal bacteremia or meningitis.


METHODS
Consecutive patients admitted between 1989 and 1991.


METHODS
None.


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 micrograms/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 beta-lactam antibiotics has increased alarmingly in South Africa. Penicillin-resistant and penicillin-susceptible pneumococcal infections cause a similar spectrum of illness.
Friedland
I R
IR
Department of Pediatrics, Baragwanath Hospital, Johannesburg, South Africa.
Klugman
K P
KP
D000367:Age Factors; D016009:Chi-Square Distribution; D002648:Child; D016001:Confidence Intervals; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D015994:Incidence; D016017:Odds Ratio; D010403:Penicillin Resistance; D011008:Pneumococcal Infections / Q000453:epidemiology* / Q000382:microbiology; D012307:Risk Factors; D012703:Serotyping; D013019:South Africa / Q000453:epidemiology; D013296:Streptococcus pneumoniae / Q000145:classification / Q000187:drug effects* / Q000302:isolation & purification