[Invasive pneumococcal pneumonia in children 0-24 months old: does bacterial resistance affect outcome]. / Neumonía neumocócica invasiva en niños de 0 a 24 meses: influye la resistencia bacteriana en la evolución?

INTRODUCTION: In Uruguay community acquired bacterial pneumonia is a significant cause of morbidity and mortality. S. pneumoniae is the most frequent agent. The disease is more severe in children less than two years old. The relationship between pneumococcal penicillin resistance and outcome is still an unresolved problem. OBJECTIVES: To compare the outcome of children 0 to 24 months old hospitalized in the Hospital Pediátrico-Centro Hospitalario Pereira Rossell, with invasive pneumococcal pneumonia caused by S. pneumoniae susceptible and resistant to penicillin. PATIENTS AND METHODS: Children 0 to 24 months old with invasive pneumococcal pneumonia, admitted between January 1st 1998 and December 31st 2005 were included. Susceptibility to penicillin was defined as a MIC < 0.06 microg/ml, reduced susceptibility was defined as a MIC of 0.1 to 1 microg/ml (intermediate) and as a MIC >or= 2 microg/ml (resistant). Outcome was evaluated with the following criteria: empyema, sepsis, septic shock, mechanical ventilation, and death. Length of hospital stay and outcome were compared in both groups. RESULTS: Inclusion criteria were met by 168 children. S. pneumoniae was susceptible to penicillin in 90 children and with reduced susceptibility in 78. Both groups were similar in age, comorbidity, nutritional status and initial antibiotic treatment. There were no significant differences in outcome and length of hospital stay. CONCLUSIONS: S. pneumoniae resistance to penicillin did not affect the outcome of pneumonia in this group of children.

Neumonía neumocócica invasiva en niños de 0 a 24 meses: ¿influye la resistencia bacteriana en la evolución? / Invasive pneumococcal pneumonia in children 0-24 months old: does bacterial resistance affect outcome?

Introducción. En Uruguay, la neumonía bacteriana adquirida en la comunidad causa una importante morbimortalidad. Streptococcus pneumoniae es el agente etiológico más frecuente. La enfermedad es más grave en niños menores de 2 años. Un interrogante aún no totalmente aclarado es la relación que existe entre la susceptibilidad disminuida del neumococo a la penicilina y su evolución. Objetivos. Comparar la evolución de niños de 0 a 24 meses de edad hospitalizados en el Hospital Pediátrico del Centro Hospitalario Pereira Rossell con neumonía invasiva por cepas de S. pneumoniae sensibles y con susceptibilidad disminuida a la penicilina. Pacientes y métodos. Se incluyó a los niños de 0 a 24 meses, hospitalizados entre el 1 de enero de 1998 y el 31 de diciembre de 2005, con neumonía neumocócica invasiva, en los que se determinó la concentración inhibitoria mínima (CIM) para la penicilina. Se consideraron sensibles las cepas con CIM <0,06 g/ml y con una susceptibilidad disminuida las cepas con CIM entre 0,1 y 1 g/ml (susceptibilidad intermedia) y las cepas con CIM 3 2 g/ml (resistentes). Se comparó la duración de la estancia hospitalaria y la evolución de ambos grupos a través de la presencia de los siguientes criterios de gravedad: empiema, sepsis, shock séptico, necesidad de asistencia ventilatoria mecánica y muerte. Resultados. Cumplieron los criterios de inclusión 168 niños. Las cepas de S. pneumoniae fueron sensibles a penicilina en 90 niños y con susceptibilidad disminuida en 78. Ambos grupos fueron comparables en relación con la edad, la comorbilidad, el estado nutricional y el tratamiento antibiótico al ingreso. La evolución medida por los criterios de gravedad mencionados no mostró diferencias significativas. El promedio de estancia hospitalaria fue similar en ambos grupos. Conclusiones. La resistencia de S. pneumoniae a la penicilina no influyó en la evolución de la neumonía en este grupo de niños

Introduction. In Uruguay community acquired bacterial pneumonia is a significant cause of morbidity and mortality. S. pneumoniae is the most frequent agent. The disease is more severe in children less than two years old. The relationship between pneumococcal penicillin resistance and outcome is still an unresolved problem. Objectives. To compare the outcome of children 0 to 24 months old hospitalized in the Hospital Pediátrico-Centro Hospitalario Pereira Rossell, with invasive pneumococcal pneumonia caused by S. pneumoniae susceptible and resistant to penicillin. Patients and methods. Children 0 to 24 months old with invasive pneumococcal pneumonia, admitted between January 1st 1998 and December 31st 2005 were included. Susceptibility to penicillin was defined as a MIC < 0.06 g/ml, reduced susceptibility was defined as a MIC of 0.1 to 1 g/ml (intermediate) and as a MIC 3 2 g/ml (resistant). Outcome was evaluated with the following criteria: empyema, sepsis, septic shock, mechanical ventilation, and death. Length of hospital stay and outcome were compared in both groups. Results. Inclusion criteria were met by 168 children. S. pneumoniae was susceptible to penicillin in 90 children and with reduced susceptibility in 78. Both groups were similar in age, comorbidity, nutritional status and initial antibiotic treatment. There were no significant differences in outcome and length of hospital stay. Conclusions. S. pneumoniae resistance to penicillin did not affect the outcome of pneumonia in this group of children