title: Outcome of invasive infections outside the central nervous system caused by Streptococcus pneumoniae isolates nonsusceptible to ceftriazone in children treated with beta-lactam antibiotics.
abstract: OBJECTIVE
  To determine the outcome of children treated primarily with beta-lactam antibiotics for a systemic infection outside the central nervous system (CNS) caused by isolates of Streptococcus pneumoniae nonsusceptible to ceftriaxone (MIC > or = 1.0 microg/ml).
  
  
  METHODS
  Retrospective review of the medical records of children identified prospectively with invasive infections outside of the CNS caused by isolates of S. pneumoniae that were not susceptible to ceftriaxone between September, 1993, and August, 1999. A subset of this group treated primarily with beta-lactam antibiotics was analyzed for outcome.
  
  
  METHODS
  Infants and children with pneumococcal infections cared for at eight children's hospitals.
  
  
  RESULTS
  Among 2,100 patients with invasive infections outside the CNS caused by S. pneumoniae, 166 had isolates not susceptible to ceftriaxone. One hundred patients treated primarily with beta-lactam antibiotics were identified. From this group 71 and 14 children had bacteremia alone or with pneumonia, respectively, caused by strains with an MIC of 1.0 microg/ml. Bacteremia or pneumonia caused by isolates with a ceftriaxone MIC > or = 2.0 microg/ml occurred in 6 and 5 children, respectively. Three children with septic arthritis and 1 with cellulitis had infections caused by strains with an MIC to ceftriaxone of 1.0 microg/ml. Most were treated with parenteral ceftriaxone, cefotaxime or cefuroxime for one or more doses followed by an oral antibiotic. All but one child were successfully treated. The failure occurred in a child with severe combined immune deficiency and bacteremia (MIC = 1.0 microg/ml) who remained febrile after a single dose of ceftriaxone followed by 12 days of cefprozil.
  
  
  CONCLUSIONS
  Ceftriaxone, cefotaxime or cefuroxime are adequate to treat invasive infections outside the CNS caused by pneumococcal isolates with MICs up to 2.0 microg/ml, a concentration currently considered resistant for these antibiotics by National Committee for Clinical Laboratory Standards breakpoints.
authors.affiliation: Pediatric Infectious Diseases Section, Baylor College of Medicine, Houston, TX, USA. skaplan@bcm.tmc.edu
authors.forename: S L
authors.initials: SL
authors.lastname: Kaplan
authors.forename: E O
authors.initials: EO
authors.lastname: Mason
authors.forename: W J
authors.initials: WJ
authors.lastname: Barson
authors.forename: T Q
authors.initials: TQ
authors.lastname: Tan
authors.forename: G E
authors.initials: GE
authors.lastname: Schutze
authors.forename: J S
authors.initials: JS
authors.lastname: Bradley
authors.forename: L B
authors.initials: LB
authors.lastname: Givner
authors.forename: K S
authors.initials: KS
authors.lastname: Kim
authors.forename: R
authors.initials: R
authors.lastname: Yogev
authors.forename: E R
authors.initials: ER
authors.lastname: Wald
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy*; D002439:Cefotaxime / Q000627:therapeutic use; D002443:Ceftriaxone / Q000627:therapeutic use*; D002444:Cefuroxime / Q000627:therapeutic use; D018550:Cephalosporin Resistance; D002511:Cephalosporins / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D011008:Pneumococcal Infections / Q000188:drug therapy*; D011018:Pneumonia, Pneumococcal / Q000188:drug therapy; D012189:Retrospective Studies; D013296:Streptococcus pneumoniae / Q000187:drug effects*
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D002443:Ceftriaxone; D002439:Cefotaxime; D002444:Cefuroxime