Three-year multicenter surveillance of systemic pneumococcal infections in children

Sheldon L. Kaplan, Edward O. Mason, William J. Barson, Ellen R. Wald, Moshe Arditi, Tina Q. Tan, Gordon E. Schutze, John S. Bradley, Laurence B. Givner, Kwang Sik Kim, Ram Yogev

Research output: Contribution to journalArticle

Abstract

Objective. To track antibiotic susceptibility of Streptococcus pneumoniae isolates obtained from children with systemic infections and determine outcome of treatment. Design. A 3-year (September 1993 through August 1996) prospective surveillance study of all invasive pneumococcal infections in children. Patients. Infants and children cared for at eight children's hospitals in the United States with culture-proven systemic pneumococcal infection. Results. One thousand two hundred ninety-one episodes of systemic pneumococcal infection were identified in 1255 children. An underlying illness was present in the children for 27% of the episodes. The proportion of isolates that were nonsusceptible to penicillin or ceftriaxone increased annually and nearly doubled throughout the 3-year period; for the last year the percentages of isolates nonsusceptible to penicillin and ceftriaxone were 21% and 9.3%, respectively. There was no difference in mortality between patients with penicillin-susceptible or nonsusceptible isolates. Only 1 of 742 patients with bacteremia had a repeat blood culture that was positive >1 day after therapy was started. All 24 normal children with bacteremia attributable to isolates resistant to penicillin had resolution of their infection; the most common treatment regimen was a single dose of ceftriaxone followed by an oral antibiotic. Conclusions. The percentage of pneumococcal isolates nonsusceptible to penicillin and ceftriaxone increased yearly among strains recovered from children with systemic infection. Because empiric antibiotic therapy already has changed for suspected pneumococcal infections, antibiotic resistance has not been associated with increased mortality. Careful monitoring of antibiotic susceptibility and outcome of therapy is necessary to continually reassess current recommendations for treatment.

Original languageEnglish (US)
Pages (from-to)538-545
Number of pages8
JournalPediatrics
Volume102
Issue number3 I
DOIs
StatePublished - Sep 1998
Externally publishedYes

Fingerprint

Pneumococcal Infections
Penicillins
Ceftriaxone
Anti-Bacterial Agents
Bacteremia
Infection
Therapeutics
Mortality
Microbial Drug Resistance
Streptococcus pneumoniae
Prospective Studies

Keywords

  • Antibiotic resistance
  • Outcome
  • Streptococcus pneumoniae

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Kaplan, S. L., Mason, E. O., Barson, W. J., Wald, E. R., Arditi, M., Tan, T. Q., ... Yogev, R. (1998). Three-year multicenter surveillance of systemic pneumococcal infections in children. Pediatrics, 102(3 I), 538-545. https://doi.org/10.1542/peds.102.3.538

Three-year multicenter surveillance of systemic pneumococcal infections in children. / Kaplan, Sheldon L.; Mason, Edward O.; Barson, William J.; Wald, Ellen R.; Arditi, Moshe; Tan, Tina Q.; Schutze, Gordon E.; Bradley, John S.; Givner, Laurence B.; Kim, Kwang Sik; Yogev, Ram.

In: Pediatrics, Vol. 102, No. 3 I, 09.1998, p. 538-545.

Research output: Contribution to journalArticle

Kaplan, SL, Mason, EO, Barson, WJ, Wald, ER, Arditi, M, Tan, TQ, Schutze, GE, Bradley, JS, Givner, LB, Kim, KS & Yogev, R 1998, 'Three-year multicenter surveillance of systemic pneumococcal infections in children', Pediatrics, vol. 102, no. 3 I, pp. 538-545. https://doi.org/10.1542/peds.102.3.538
Kaplan SL, Mason EO, Barson WJ, Wald ER, Arditi M, Tan TQ et al. Three-year multicenter surveillance of systemic pneumococcal infections in children. Pediatrics. 1998 Sep;102(3 I):538-545. https://doi.org/10.1542/peds.102.3.538
Kaplan, Sheldon L. ; Mason, Edward O. ; Barson, William J. ; Wald, Ellen R. ; Arditi, Moshe ; Tan, Tina Q. ; Schutze, Gordon E. ; Bradley, John S. ; Givner, Laurence B. ; Kim, Kwang Sik ; Yogev, Ram. / Three-year multicenter surveillance of systemic pneumococcal infections in children. In: Pediatrics. 1998 ; Vol. 102, No. 3 I. pp. 538-545.
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AU - Tan, Tina Q.

AU - Schutze, Gordon E.

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N2 - Objective. To track antibiotic susceptibility of Streptococcus pneumoniae isolates obtained from children with systemic infections and determine outcome of treatment. Design. A 3-year (September 1993 through August 1996) prospective surveillance study of all invasive pneumococcal infections in children. Patients. Infants and children cared for at eight children's hospitals in the United States with culture-proven systemic pneumococcal infection. Results. One thousand two hundred ninety-one episodes of systemic pneumococcal infection were identified in 1255 children. An underlying illness was present in the children for 27% of the episodes. The proportion of isolates that were nonsusceptible to penicillin or ceftriaxone increased annually and nearly doubled throughout the 3-year period; for the last year the percentages of isolates nonsusceptible to penicillin and ceftriaxone were 21% and 9.3%, respectively. There was no difference in mortality between patients with penicillin-susceptible or nonsusceptible isolates. Only 1 of 742 patients with bacteremia had a repeat blood culture that was positive >1 day after therapy was started. All 24 normal children with bacteremia attributable to isolates resistant to penicillin had resolution of their infection; the most common treatment regimen was a single dose of ceftriaxone followed by an oral antibiotic. Conclusions. The percentage of pneumococcal isolates nonsusceptible to penicillin and ceftriaxone increased yearly among strains recovered from children with systemic infection. Because empiric antibiotic therapy already has changed for suspected pneumococcal infections, antibiotic resistance has not been associated with increased mortality. Careful monitoring of antibiotic susceptibility and outcome of therapy is necessary to continually reassess current recommendations for treatment.

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