Childhood pneumococcal bacteraemia in Riyadh, Saudi Arabia

Abstract

Forty-nine children with pneumococcal bacteraemia seen during a 5-year period (1 January 1991 to 31 December 1995) at King Khalid University Hospital were studied. The majority (61.2%) were under 2 years of age. The focus of infection was pneumonia, pharyngitis or undetermined in 28.6%, 18.4% and 20.4%, respectively. Diseases that had probably predisposed them to pneumococcal bacteraemia (mainly nephrotic syndrome) were encountered in 24.5% of cases. Forty-five per cent of the cases occurred during the summer season and in 29% the disease was nosocomially acquired. No death was recorded in this series and the reasons for this are discussed. Detection of pneumococcal antigens from blood taken for culture was successful in 96% of cases; this test is important in the diagnosis of pneumococcal bacteraemia in partially treated patients. Antimicrobial susceptibility testing showed 20.4% of the isolates to be relatively penicillin-resistant. Resistance to other antimicrobial agents was also recorded and multiple resistance was noted in 22% of isolates. There was a significant difference between the ceftriaxone MIC of the relatively penicillin-resistant strains compared with penicillin-sensitive strains. The emergence and the steady increase in the numbers of relatively penicillin-resistant pneumococcal strains in Saudi Arabia during the last 10 years are discussed.

Epidemiology of invasive pneumococcal disease in the Arabian Peninsula and Egypt

“…Microbiology methods in an early report used a lower MIC for 'highlevel penicillin resistance' [8], making these results incomparable with others using standard NCCLS-defined high-level resistance. Uniform methods or use of a central laboratory would eliminate this discrepancy.…”

“…Risk factors that are frequently noted in KSA include nephrotic syndrome, steroid therapy, sickle cell disease, liver disease, heart disease and neutropenia [8]. Immunising children with co-morbidities (e.g.…”

“…From the available data, the reported rate of IPD per 100 000 (by age) ranged from a low of 3.4 (<5 years) in KSA [11] to a high of 53.5 (<5 years) in KSA [14]. Pneumococcus accounted for a large percentage of bacteraemia isolates, ranging from a low of 61% (<2 years) in KSA [10] to a high of 100% (<2 years) in KSA [8]. In children aged <2 years the percentage of IPD cases attributed to meningitis ranged from 3% in Egypt [16] to 25% in Egypt [17] and KSA [9], and in children ≤5 years the figure ranged from 7% in Egypt [17] to 30% in Egypt [15].…”

“…In all countries with early (pre-2000) and later (post-2000) studies there was an apparent increase in non-susceptibility to penicillin. In recent studies, resistance to third-generation cephalosporins also emerged, from a low of 0% in KSA (<14 years) and Egypt (≤5 years) until 2000 [8,9,15] to a high of 12% in Qatar (<12 years) in 2002 [20]. For older children, penicillin resistance ranged from a low of 0% in KSA (<13 years) and Kuwait (<12 years) during 1981-1995 [12,22] to a high of 78% (<20 years) in KSA during 2000 [7] (intermediateor high-level resistance).…”

“…An earlier 5-year retrospective study was conducted from 1991 to 1995 in one hospital in Riyadh [8]. Forty-nine children <14 years of age with pneumococcal bacteraemia were included.…”