title: Penicillin-resistant systemic pneumococcal infections in children: a retrospective case-control study.
abstract: OBJECTIVE
  To determine whether there are any risk factors that differentiate children with systemic infections due to Streptococcus pneumoniae relatively or fully resistant (minimum inhibitory concentration > 0.1 microgram/mL) to penicillin from those children with infections due to S pneumoniae susceptible to penicillin.
  
  
  METHODS
  Retrospective case-control study.
  
  
  METHODS
  A large children's hospital.
  
  
  METHODS
  Forty-three children with systemic penicillin-resistant S pneumoniae infections identified at Texas Children's Hospital over the 51-month period from January 1989 through March 1993. Each case had one or two controls matched only for age and date of S. pneumoniae infection. Sixty-six controls were selected from a group of 341 children with susceptible isolates.
  
  
  METHODS
  Variables compared included gender, race, diagnosis, underlying conditions, past hospitalization, geographic area of residence, antibiotic use in past month, amoxicillin-clavulanic acid use in past month, and outcome.
  
  
  RESULTS
  Thirty-seven patients (86%) had relatively resistant isolates (minimum inhibitory concentration range 0.125 to 1.0 microgram/mL) and six patients (15%) had fully resistant isolates (minimum inhibitory concentration range 2.0 to 8.0 micrograms/mL). Thirty-three percent of the cases vs 36% of the controls had underlying conditions. Seventy-one percent of the cases vs 39% of the controls had received antibiotics in the previous month. Compared with their matched controls, the patients with penicillin-resistant systemic pneumococcal infections were more likely (P = .02) to have received a course of antibiotics within the month prior to their infection.
  
  
  CONCLUSIONS
  The only identified associated risk factor in children who developed a systemic penicillin-resistant pneumococcal infection appears to have been the use of antibiotics within the month prior to their infection.
authors.affiliation: Department of Pediatrics, Baylor College of Medicine, Houston, TX.
authors.forename: T Q
authors.initials: TQ
authors.lastname: Tan
authors.forename: E O
authors.initials: EO
authors.lastname: Mason
authors.forename: S L
authors.initials: SL
authors.lastname: Kaplan
mesh_terms: D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010403:Penicillin Resistance; D011008:Pneumococcal Infections / Q000188:drug therapy*; D012189:Retrospective Studies; D013296:Streptococcus pneumoniae / Q000187:drug effects / Q000302:isolation & purification; D016896:Treatment Outcome