Lower respiratory tract infection in hospitalized children.
OBJECTIVE
The aim of the present study was to investigate the aetiology and antibiotic-resistance patterns of community-acquired lower respiratory tract infection (LRTI) in 1999 and compare it with data from 1995 and 1988.


METHODS
A prospective observational study of LRTI in hospitalized children at KK Women's & Children's Hospital, Singapore, was undertaken.


RESULTS
A positive isolate was found in 58% of patients (671/1158), comprising viruses (n = 477, 41.2%), non-type B Haemophilus influenzae (n = 101, 8.7%), Streptococcus pneumoniae (n = 66, 5.7%), Mycoplasma pneumoniae (n = 92, 8%), Moraxella catarrhalis (n = 19, 1.6%) and other bacteria (n = 19, 1.6%). Mixed virus-bacteria (n = 104, 9%) infections were comprised mostly of virus-H. influenzae combinations. In 1999, S. pneumoniae resistance rates were penicillin 44.6% (17%, 1995), amoxycillin 3% (18%, 1995; MIC 0.5-2 microg/mL reclassified as susceptible in 1999), erythromycin 55% (30%, 1995), trimethoprim-sulfamethoxazole (TMP/SMX) 60% (23%, 1995). H. influenzaeresistance rates were amoxycillin 26.7% (38%, 1995), erythromycin 99% (37%, 1995), TMP/SMX 98% (37%, 1995). There were 15 cases of empyema of which seven were proven S. pneumoniae and there was one pneumococcal death (0.08%).


CONCLUSIONS
Pneumococcal pneumonia needs to be treated aggressively due to its high morbidity. Amoxycillin still remains useful for treating pneumococcus despite an increasing resistance to penicillin, erythromycin and TMP/SMX. Judicious use of antibiotics is needed to curb the increasing rate of antibiotic-resistance.
Yin
Chong Chia
CC
Department of Paediatric Medicine, KK Women's & Children's Hospital, Republic of Singapore. cychong@kkh.com.sg
Huah
Lim Woan
LW
Lin
Jenny Tang Poh
JT
Goh
Anne
A
Ling
Ho
H
Moh
Chay Oh
CO
D000293:Adolescent; D017677:Age Distribution; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D004352:Drug Resistance, Microbial; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008826:Microbial Sensitivity Tests; D018410:Pneumonia, Bacterial / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D011024:Pneumonia, Viral / Q000188:drug therapy / Q000453:epidemiology* / Q000821:virology; D011379:Prognosis; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D012846:Singapore / Q000453:epidemiology; D015996:Survival Rate
D000900:Anti-Bacterial Agents