Clinical outcome of invasive infections by penicillin-resistant Streptococcus pneumoniae in Korean children

One hundred six cases of invasive pneumococcal infections diagnosed from 1985 to 1996 were analyzed retrospectively. The types of infection were bacteremia without focus (45%), meningitis (19%), peritonitis (17%), pneumonia (bacteremic) (16%), and others (3%). Penicillin-nonsusceptible Streptococcus pneumoniae was first detected in 1989, and its incidence increased rapidly thereafter, reaching 89% in 1995. Initial empirical regimens were of parenteral beta-lactam antimicrobials with or without an aminoglycoside, but these were modified subsequently. Among the 72 nonmeningeal infections analyzed, a favorable response at 72 hours and death were observed in 83% and 2.5%, respectively, of 40 penicillin-susceptible infections, as compared with 86% (P = 1.0) and 7.1% (P = .45) of 14 infections due to intermediate strains and 61% (P = .07) and 11% (P = .22) of 18 due to resistant strains. The favorable-response rate and mortality among 49 patients not in initially critical condition were 92% and zero, respectively, as compared with 52% (P = .00027) and 17% (P = .008) of 23 in critical condition. The data suggest that clinical outcome of penicillin-nonsusceptible pneumococcal infection outside the CNS may be more closely related to clinical condition at presentation than to the level of resistance of the causative strain when such infection is treated with parenteral beta-lactams.