title: Comparative analysis of outcome and clinical features in children with pleural empyema caused by penicillin-nonsusceptible and penicillin-susceptible Streptococcus pneumoniae.
abstract: OBJECTIVE
  To describe the clinical characteristics of pleural empyema in children caused by Streptococcus pneumoniae nonsusceptible to penicillin and compare their clinical outcome with pleural empyemas caused by penicillin-susceptible organisms.
  
  
  METHODS
  Records of 109 children with complicated pleural effusions between January 1996 and December 1998 were retrospectively reviewed.
  
  
  RESULTS
  Pathogens were recovered in 45 of these cases. Streptococcus pneumoniae represented 71% of the isolates, with 20 (62%) and 12 (38%) of the strains proving susceptible and nonsusceptible to penicillin, respectively. The average age for children with penicillin-nonsusceptible infections was 18.3 months compared with an average age of 40.9 months for those with penicillin-susceptible infections (P = 0.03). Previous antibiotic treatment was more frequent in children with penicillin-nonsusceptible organisms (P = 0.05). No significant differences were found between the two groups for gender, underlying diseases, duration of fever and tachypnea, need of surgical treatment, bacteremia incidence, mean duration of therapy, or length of hospital stay.
  
  
  CONCLUSIONS
  Pleural empyemas caused by penicillin-nonsusceptible S. pneumoniae appear to be associated with younger age and previous antibiotic treatment. By contrast, the outcome was not influenced by the penicillin susceptibility of the pneumococcus strains.
authors.affiliation: Department of Infectious Diseases and Epidemiology, Hospital de Pediatría Profesor Dr. Juan P. Garrahan, Buenos Aires, Argentina. hpaganini@intramed.net.ar
authors.forename: H
authors.initials: H
authors.lastname: Paganini
authors.forename: J R
authors.initials: JR
authors.lastname: Guiñazú
authors.forename: C
authors.initials: C
authors.lastname: Hernández
authors.forename: H
authors.initials: H
authors.lastname: Lopardo
authors.forename: F
authors.initials: F
authors.lastname: Gonzalez
authors.forename: G
authors.initials: G
authors.lastname: Berberian
mesh_terms: D016470:Bacteremia / Q000209:etiology; D002675:Child, Preschool; D016724:Empyema, Pleural / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D007902:Length of Stay; D008297:Male; D010403:Penicillin Resistance; D010406:Penicillins / Q000494:pharmacology / Q000627:therapeutic use*; D013290:Streptococcal Infections / Q000188:drug therapy* / Q000382:microbiology; D013296:Streptococcus pneumoniae / Q000187:drug effects*; D016896:Treatment Outcome
chemical_list: D010406:Penicillins