Antibiotic-Resistant Pneumococcal Disease in South African Children

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. INTERVENTIONS: 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 micrograms/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 beta-lactam antibiotics has increased alarmingly in South Africa. Penicillin-resistant and penicillin-susceptible pneumococcal infections cause a similar spectrum of illness.