Penicillin-resistant pneumococci from pediatric patients in the Washington, DC, area
A. Pikis, S. Akram, J. A. Donkersloot, J. M. Campos and W. J. Rodriguez
Department of Infectious Diseases, Children's National Medical Center, Washington, DC.
OBJECTIVE: To assess the prevalence and antimicrobial susceptibility of
penicillin-resistant pneumococci (PRP) isolated from patients in a
pediatric hospital. METHODS: All (108) isolates of Streptococcus pneumoniae
recovered from usually sterile body sites between June 1, 1992, and May 31,
1993, were screened for susceptibility to penicillin by the E-test method.
Minimum inhibitory concentrations of penicillin and other antibiotics were
also determined by an agar dilution method for 10 PRP and 22
penicillin-susceptible strains. RESULTS: Fourteen isolates (12.9%) were PRP
by the E-test; nine of these (8.3%) were intermediately resistant and five
(4.6%) were highly resistant. All strains were sensitive to rifampin and
vancomycin. Increased frequency of resistance to oral and parenteral
cephalosporins and carbapenems was found among PRP; for most of these
antibiotics, resistance exceeded 40% of the PRP. In addition, 20% of the
PRP were resistant to macrolides and all penicillin-susceptible and PRP
were resistant to a combination of trimethoprim and sulfamethoxazole.
CONCLUSIONS: The decreased susceptibility to oral and parenteral
cephalosporins, macrolides, a combination of trimethoprim and
sulfamethoxazole, and carbapenems creates a significant problem in the
treatment of pneumococcal infections in both ambulatory and hospitalized
patients.
