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Antibiotic-Resistant Pneumococcal Disease in South African Children

Ian R. Friedland, MB, BCh, MMed DTM&H; Keith P. Klugman, MB, BCh, MRCPath, PhD, DTM&H
Am J Dis Child. 1992;146(8):920-923. doi:10.1001/archpedi.1992.02160200042023.
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• Objective.  —To determine the incidence of antibiotic-resistant pneumococcal disease and to compare the presentation and outcome of penicillin-resistant infections with penicillin-susceptible infections.

Design.  —Patient series.

Setting.  —General community hospital.

Patients.  —Eighty-three children with penicillin-resistant pneumococcal bacteremia or meningitis and 124 children with penicillin-susceptible pneumococcal bacteremia or meningitis.

Selection Procedures.  —Consecutive patients admitted between 1989 and 1991.

Intervention.  —None.

Measurements and Results.  —Forty percent of community-acquired isolates and 95% of hospital-acquired isolates were resistant to penicillin. Eighty-three (82%) of 101 penicillin-resistant infections were community acquired. Resistance to chloramphenicol, tetracycline, and erythromycin occurred in 9%, 12%, and 4% of all isolates, respectively. The proportion of penicillin-resistant pneumococci with cefotaxime minimum inhibitory concentrations greater than or equal to 0.5 μg/mL increased from 0% in a 1986 study to 21.5% in this study. The sites of infection, underlying diseases, and mortality of patients with penicillin-resistant infections outside the central nervous system did not differ significantly from those of penicillin-susceptible infections.

Conclusions.  —The resistance of Streptococcus pneumoniae to β-lactam antibiotics has increased alarmingly in South Africa. Penicillin-resistant and penicillin-susceptible pneumococcal infections cause a similar spectrum of illness.(AJDC. 1992;146:920-923)

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