title: Clinical characteristics and outcome of children with pneumonia attributable to penicillin-susceptible and penicillin-nonsusceptible Streptococcus pneumoniae.
abstract: OBJECTIVE
  To compare the clinical characteristics, treatment, and outcome of pediatric patients with pneumonia attributable to isolates of Streptococcus pneumoniae that were either susceptible or nonsusceptible to penicillin.
  
  
  METHODS
  Multicenter, retrospective study.
  
  
  METHODS
  Eight children's hospitals in the United States.
  
  
  METHODS
  Two hundred fifty-four children with pneumococcal pneumonia identified from patients enrolled in the United States Pediatric Multicenter Pneumococcal Surveillance Study during the 3-year period from September 1, 1993 to August 31, 1996.
  
  
  METHODS
  Demographic and clinical variables including necessity for and duration of hospitalization, frequency of chest tube placement, antimicrobial therapy, susceptibility of isolates, and clinical outcome.
  
  
  RESULTS
  There were 257 episodes of pneumococcal pneumonia that occurred in 254 patients. Of the 257 isolates, 22 (9%) were intermediate and 14 (6%) were resistant to penicillin; 7 (3%) were intermediate to ceftriaxone and 5 (2%) were resistant to ceftriaxone. There were no differences noted in the clinical presentation of the patients with susceptible versus nonsusceptible isolates. Twenty-nine percent of the patients had a pleural effusion. The 189 (74%) hospitalized patients were more likely to have an underlying illness, multiple lung lobe involvement, and the presence of a pleural effusion than nonhospitalized patients. Fifty-two of 72 hospitalized patients with pleural effusions had a chest tube placed, and 27 subsequently underwent a decortication drainage procedure. Eighty percent of the patients treated as outpatients and 48% of the inpatients received a parenteral second or third generation cephalosporin followed by a course of an oral antimicrobial agent. Two hundred forty-eight of the patients (97.6%) had a good response to therapy. Six patients died; however, only 1 of the deaths was related to the pneumococcal infection.
  
  
  CONCLUSIONS
  The clinical presentation and outcome of therapy did not differ significantly between patients with penicillin-susceptible versus those with nonsusceptible isolates of S pneumoniae. Hospitalized patients were more likely to have underlying illnesses, multiple lobe involvement, and the presence of pleural effusions than patients who did not require hospitalization. In otherwise normal patients with pneumonia attributable to penicillin-resistant pneumococcal isolates, therapy with standard beta-lactam agents is effective.
authors.affiliation: Pediatric Infectious Disease, Chicago, Illinois, USA.
authors.forename: T Q
authors.initials: TQ
authors.lastname: Tan
authors.forename: E O
authors.initials: EO
authors.lastname: Mason
authors.forename: W J
authors.initials: WJ
authors.lastname: Barson
authors.forename: E R
authors.initials: ER
authors.lastname: Wald
authors.forename: G E
authors.initials: GE
authors.lastname: Schutze
authors.forename: J S
authors.initials: JS
authors.lastname: Bradley
authors.forename: M
authors.initials: M
authors.lastname: Arditi
authors.forename: L B
authors.initials: LB
authors.lastname: Givner
authors.forename: R
authors.initials: R
authors.lastname: Yogev
authors.forename: K S
authors.initials: KS
authors.lastname: Kim
authors.forename: S L
authors.initials: SL
authors.lastname: Kaplan
mesh_terms: D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002443:Ceftriaxone / Q000627:therapeutic use; D002444:Cefuroxime / Q000627:therapeutic use; D002511:Cephalosporins / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D016724:Empyema, Pleural / Q000209:etiology; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008826:Microbial Sensitivity Tests; D010403:Penicillin Resistance; D010406:Penicillins / Q000494:pharmacology / Q000627:therapeutic use; D010996:Pleural Effusion / Q000209:etiology; D011018:Pneumonia, Pneumococcal / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000628:therapy; D012189:Retrospective Studies; D013296:Streptococcus pneumoniae / Q000187:drug effects*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D010406:Penicillins; D002443:Ceftriaxone; D002444:Cefuroxime