Pneumococcal bacteremia during a decade in children in Soweto, South Africa

Objectives. To monitor for a decade the incidence and the clinical and microbiologic characteristics of pneumococcal bacteremia in children in Soweto and to assess the influence of HIV infection on any changes. Methods. Case records of children with pneumococcal bacteremia at Chris Hani Baragwanath Hospital from July, 1986, to June, 1987 (1986/1987), and from July, 1996, to June, 1997 (1996/1997), were retrospectively reviewed. Results. There were 194 episodes, 62 in 1986/1987 and 132 in 1996/1997. The minimum annual incidence for children younger than 5 years of age increased from 61 per 100 000 (179 per 100 000 for those <12 months old) in 1986/1987 to 130 per 100 000 (349 per 100 000 for those <12 months old) in 1996/1997, Sixty-seven (60%) of 111 patients tested in 1996/1997 were HIV-seropositive; none were tested in 1986/1987. The HIV-infected compared with HIV-noninfected were more likely to be malnourished (61% vs. 36%, P = 0.02), less likely to have other underlying disease (12% vs. 50%, P = 0.00001) and more frequently used antibiotics recently (69% vs. 43%, P = 0.008). Penicillin-nonsusceptible isolates were found in 22 (35%) patients in 1986/1987 and 52 (39%) in 1996/1997, There was no significant change in antimicrobial susceptibility during the decade or by HIV serostatus. Conclusions. Children in Soweto had a high incidence of pneumococcal bacteremia which doubled during the decade mainly as a result of the impact of the HIV epidemic. There has been no significant change in antimicrobial susceptibility for the decade.