1
|
Forster J, Piazza G, Goettler D, Tanzberger EL, Kenntner S, Schoen C, Streng A, Liese JG. Empiric Antibiotic Therapy in 1402 Children With Parapneumonic Effusion/Pleural Empyema in Germany: A Long-term Surveillance Study. Pediatr Infect Dis J 2024:00006454-990000000-00852. [PMID: 38713819 DOI: 10.1097/inf.0000000000004359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/09/2024]
Abstract
OBJECTIVE This study investigated empiric antibiotic treatment (EAT), guideline adherence, antibiotic streamlining and clinical outcomes in 1402 hospitalized children with pediatric parapneumonic effusion/pleural empyema (PPE/PE). METHODS A nationwide surveillance study collected data on EAT, clinical course/outcome, pathogens, susceptibility testing and antibiotic streamlining of children with PPE/PE in Germany between 2010 and 2018. Subgroups were compared using χ2 test/Fisher exact test, Mann-Whitney U test and linear regression analysis adjusting for patient age where appropriate. RESULTS Complete data on EAT were available for 1402 children. In children with monotherapy (n = 567) and in children with combination therapy of 2 antibiotics (n = 589), the most commonly used antibiotics were aminopenicillin/beta-lactamase inhibitor [138/567 (24.3%) and 102/589 (17.3%)] and cefuroxime [291/567 (51.3%) and 294/589 (49.9%)]. The most common combinations with these beta-lactams were macrolides, aminoglycosides and clindamycin. We observed no difference in clinical severity/outcome between EAT with aminopenicillin/beta-lactamase inhibitor and cefuroxime, neither when used in monotherapy nor when used in combination therapy of 2 antibiotics. Species diagnosis of Streptococcus pneumoniae (n = 192), Streptococcus pyogenes (n = 111) or Staphylococcus aureus (n = 38) in polymerase chain reaction or culture from pleural fluid or blood resulted in a switch to an appropriate narrow-spectrum beta-lactam therapy in 9.4%, 18.9 % and 5.2% of children. In a subset of children with reported bacterial susceptibility testing, penicillin resistance was reported in 3/63 (4.8%) of S. pneumoniae and methicillin resistance in S. aureus was reported in 10/32 (31.3%) of children. CONCLUSION This study points to antibiotic overtreatment in children with PPE/PE, particularly the frequent use of combinations of antibiotics. Children receiving combinations of antibiotics did not show differences in clinical outcomes. The low rate of children with streamlined antibiotic therapy even upon pathogen detection indicates a necessity for antibiotic stewardship measures in PPE/PE and the need of investigating other potential therapeutic strategies as anti-inflammatory therapy.
Collapse
Affiliation(s)
- Johannes Forster
- From the Institute for Hygiene and Microbiology, University of Würzburg
| | - Giuseppina Piazza
- Department of Pediatrics, University Hospital of Würzburg, Würzburg, Germany
| | - David Goettler
- Department of Pediatrics, University Hospital of Würzburg, Würzburg, Germany
| | | | - Simone Kenntner
- Department of Pediatrics, University Hospital of Würzburg, Würzburg, Germany
| | - Christoph Schoen
- From the Institute for Hygiene and Microbiology, University of Würzburg
| | - Andrea Streng
- Department of Pediatrics, University Hospital of Würzburg, Würzburg, Germany
| | - Johannes G Liese
- Department of Pediatrics, University Hospital of Würzburg, Würzburg, Germany
| |
Collapse
|
2
|
Cathalau M, Michelet M, Rancé A, Martin-Blondel G, Abbo O, Dubois D, Labouret G, Grouteau E, Claudet I, Ricco L, Roditis L, Mansuy JM, Simon S, Bréhin C. Necrotizing pneumonia in children: Report of 25 cases between 2008 and 2018 at a French tertiary care center. Arch Pediatr 2024; 31:183-187. [PMID: 38485569 DOI: 10.1016/j.arcped.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 11/21/2023] [Accepted: 12/30/2023] [Indexed: 04/07/2024]
Abstract
BACKGROUND Necrotizing pneumonia (NP) is a serious and rare disease in children. Pediatric data on NP are limited and the impact of the 13-valent pneumococcal conjugate vaccine has been very poorly evaluated. PATIENTS AND METHODS We conducted a retrospective study at Toulouse University Hospital between 2008 and 2018. Children who presented with thin-walled cavities in the areas of parenchymal consolidation on imaging were included in the study. RESULTS The incidence of NP did not decrease during this period. Bacterial identification occurred in 56% of cases (14/25) and included six cases of Streptococcus pneumoniae, five of Staphylococcus aureus, two of Streptococcus pyogenes, and one of Streptococcus viridans. Streptococcus pneumoniae NP are more frequently associated with empyema/parapneumonic effusion compared to S. aureus NP (p = 0.02). Patients with S. pyogenes NP more often required volume expansion than did S. pneumoniae cases (p = 0.03). When comparing children born before and after implementation of the 13-valent pneumococcal conjugate vaccine, we identified a relative modification of the bacterial epidemiology, with an increase in the proportion of S. pyogenes NP and S. aureus NP and a decrease in the proportion of NP caused by S. pneumoniae. CONCLUSION Future studies are needed to assess the epidemiology of NP in children. Continued surveillance of identified pneumococcal serotypes is essential to document epidemiological changes in the coming years.
Collapse
Affiliation(s)
- Manon Cathalau
- Children's Hospital, University Hospital Center of Toulouse, 330 avenue de Grande Bretagne, 31300, Toulouse, France
| | - Marine Michelet
- Pediatric Pneumology Department, University Hospital Center of Toulouse, 330 avenue de Grande Bretagne, 31300, Toulouse, France
| | - Aurélien Rancé
- Pediatric Pneumology Department, University Hospital Center of Toulouse, 330 avenue de Grande Bretagne, 31300, Toulouse, France
| | - Guillaume Martin-Blondel
- Infectious Diseases Department, University Hospital Center of Toulouse, 330 avenue de Grande Bretagne, 31300, Toulouse, France
| | - Olivier Abbo
- Infantile Visceral Surgery Department, University Hospital Center of Toulouse, 330 avenue de Grande Bretagne, 31300, Toulouse, France
| | - Damien Dubois
- Federal Institute of Biology, Bacteriology unit, University Hospital Center of Toulouse, 330 avenue de Grande Bretagne, 31300, Toulouse, France
| | - Géraldine Labouret
- Pediatric Pneumology Department, University Hospital Center of Toulouse, 330 avenue de Grande Bretagne, 31300, Toulouse, France
| | - Erick Grouteau
- General Pediatrics Unit, University Hospital Center of Toulouse, 330 avenue de Grande Bretagne, 31300, Toulouse, France
| | - Isabelle Claudet
- Pediatric Emergency Care Unit, University Hospital Center of Toulouse, 330 avenue de Grande Bretagne, 31300, Toulouse, France
| | - Lucas Ricco
- General Pediatrics Unit, University Hospital Center of Toulouse, 330 avenue de Grande Bretagne, 31300, Toulouse, France
| | - Léa Roditis
- Pediatric Pneumology Department, University Hospital Center of Toulouse, 330 avenue de Grande Bretagne, 31300, Toulouse, France
| | - Jean-Michel Mansuy
- Federal Institute of Biology, Virology unit, University Hospital Center of Toulouse, 330 avenue de Grande Bretagne, 31300, Toulouse, France
| | - Sophie Simon
- Pediatric Radiology Department, University Hospital Center of Toulouse, 330 avenue de Grande Bretagne, 31300, Toulouse, France
| | - Camille Bréhin
- General Pediatrics Unit, University Hospital Center of Toulouse, 330 avenue de Grande Bretagne, 31300, Toulouse, France.
| |
Collapse
|
3
|
Mercadante S, Ficari A, Romani L, De Luca M, Tripiciano C, Chiurchiù S, Calo Carducci FI, Cursi L, Di Giuseppe M, Krzysztofiak A, Bernardi S, Lancella L. The Thousand Faces of Invasive Group A Streptococcal Infections: Update on Epidemiology, Symptoms, and Therapy. CHILDREN (BASEL, SWITZERLAND) 2024; 11:383. [PMID: 38671600 PMCID: PMC11048970 DOI: 10.3390/children11040383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 03/15/2024] [Accepted: 03/20/2024] [Indexed: 04/28/2024]
Abstract
Invasive infections caused by Streptococcus pyogfenes (iGAS), commonly known as Group A Streptococcus, represent a significant public health concern due to their potential for rapid progression and life-threatening complications. Epidemiologically, invasive GAS infections exhibit a diverse global distribution, affecting individuals of all ages with varying predisposing factors. The pathogenesis of invasive GAS involves an array of virulence factors that contribute to tissue invasion, immune evasion, and systemic dissemination. In pediatrics, in the last few years, an increase in iGAS infections has been reported worldwide becoming a challenging disease to diagnose and treat promptly. This review highlights the current knowledge on pathogenesis, clinical presentations, and therapeutic approaches for iGAS in children.
Collapse
Affiliation(s)
- Stefania Mercadante
- Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (S.M.); (L.R.); (C.T.); (S.C.); (S.B.); (L.L.)
| | - Andrea Ficari
- Residency School of Pediatrics, University of Rome Tor Vergata, 00133 Rome, Italy;
| | - Lorenza Romani
- Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (S.M.); (L.R.); (C.T.); (S.C.); (S.B.); (L.L.)
| | - Maia De Luca
- Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (S.M.); (L.R.); (C.T.); (S.C.); (S.B.); (L.L.)
| | - Costanza Tripiciano
- Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (S.M.); (L.R.); (C.T.); (S.C.); (S.B.); (L.L.)
| | - Sara Chiurchiù
- Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (S.M.); (L.R.); (C.T.); (S.C.); (S.B.); (L.L.)
| | - Francesca Ippolita Calo Carducci
- Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (S.M.); (L.R.); (C.T.); (S.C.); (S.B.); (L.L.)
| | - Laura Cursi
- Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (S.M.); (L.R.); (C.T.); (S.C.); (S.B.); (L.L.)
| | - Martina Di Giuseppe
- Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (S.M.); (L.R.); (C.T.); (S.C.); (S.B.); (L.L.)
| | - Andrzej Krzysztofiak
- Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (S.M.); (L.R.); (C.T.); (S.C.); (S.B.); (L.L.)
| | - Stefania Bernardi
- Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (S.M.); (L.R.); (C.T.); (S.C.); (S.B.); (L.L.)
| | - Laura Lancella
- Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (S.M.); (L.R.); (C.T.); (S.C.); (S.B.); (L.L.)
| |
Collapse
|
4
|
Peetermans M, Matheeussen V, Moerman C, De Rydt F, Thieren S, Pollet E, Casaer M, De Backer B, De Paep R, Debaveye Y, Desmet L, Desmet S, Duval EIM, Fraipont V, Geysels D, Hermans G, Lahaye F, Mathy X, Meersseman P, Meex C, Van Herck J, van Kleef-van Koeveringe S, Layios N, Wauters J, Jorens PG. Clinical and molecular epidemiological features of critically ill patients with invasive group A Streptococcus infections: a Belgian multicenter case-series. Ann Intensive Care 2024; 14:19. [PMID: 38286885 PMCID: PMC10825083 DOI: 10.1186/s13613-024-01249-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 01/14/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Recent alerts have highlighted an increase in group A streptococcal (GAS) infections since 2022 in Europe and the United States. Streptococcus pyogenes can cause limited skin or mucosal disease, but can also present as severe invasive disease necessitating critical care. We performed a multicenter retrospective study of patients with GAS infections recently admitted to Belgian intensive care units (ICUs) since January 2022. We describe patient characteristics and investigate the molecular epidemiology of the S. pyogenes strains involved. RESULTS Between January 2022 and May 2023, a total of 86 cases (56 adults, 30 children) with GAS disease were admitted to critical care in the university hospitals of Leuven, Antwerp and Liège. We noted a strikingly high incidence of severe community-acquired pneumonia (sCAP) (45% of adults, 77% of children) complicated with empyema in 45% and 83% of adult and pediatric cases, respectively. Two-thirds of patients with S. pyogenes pneumonia had viral co-infection, with influenza (13 adults, 5 children) predominating. Other disease presentations included necrotizing fasciitis (23% of adults), other severe skin/soft tissue infections (16% of adults, 13% of children) and ear/nose/throat infections (13% of adults, 13% of children). Cardiogenic shock was frequent (36% of adults, 20% of children). Fifty-six patients (65%) had toxic shock syndrome. Organ support requirements were high and included invasive mechanical ventilation (77% of adults, 50% of children), renal replacement therapy (29% of adults, 3% of children) and extracorporeal membrane oxygenation (20% of adults, 7% of children). Mortality was 21% in adults and 3% in children. Genomic analysis of S. pyogenes strains from 55 out of 86 patients showed a predominance of emm1 strains (73%), with a replacement of the M1global lineage by the toxigenic M1UK lineage (83% of emm1 strains were M1UK). CONCLUSIONS The recent rise of severe GAS infections (2022-23) is associated with introduction of the M1UK lineage in Belgium, but other factors may be at play-including intense circulation of respiratory viruses and potentially an immune debt after the COVID pandemic. Importantly, critical care physicians should include S. pyogenes as causative pathogen in the differential diagnosis of sCAP.
Collapse
Affiliation(s)
- Marijke Peetermans
- Medical Intensive Care Unit, Department of General Internal Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
- Laboratory for Clinical Infectious and Inflammatory Disorders, Department of Microbiology, Immunology and Transplantation, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - Veerle Matheeussen
- Department of Microbiology and Belgian Reference Centre for Invasive β-Hemolytic Streptococci, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Antwerp, Belgium
- Laboratory of Medical Biochemistry and Laboratory of Medical Microbiology, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Antwerp, Belgium
| | - Cedric Moerman
- Department of Adult and Pediatric Intensive Care Medicine, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Antwerp, Belgium
- Department of Anesthesiology and Critical Care Medicine, GZA Hospital Group, Antwerp, Belgium
| | - Fréderic De Rydt
- Department of Adult and Pediatric Intensive Care Medicine, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Antwerp, Belgium
- Department of Anesthesiology, Chirec Hospitals, Brussels, Belgium
| | - Sabine Thieren
- Medical Intensive Care Unit, Department of General Internal Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
- Department of Anesthesiology, VITAZ Hospital, Sint-Niklaas, Belgium
| | - Emily Pollet
- Medical Intensive Care Unit, Department of General Internal Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Michael Casaer
- Department of Intensive Care Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
- Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Benjamin De Backer
- Service de Microbiologie Clinique, CHR Citadelle, Bd du Douzième de Ligne 1, 4000, Liège, Belgium
| | - Rudi De Paep
- Department of Adult and Pediatric Intensive Care Medicine, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Antwerp, Belgium
| | - Yves Debaveye
- Department of Intensive Care Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
- Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Lars Desmet
- Pediatric Intensive Care Unit, Department of Intensive Care Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Stefanie Desmet
- Laboratory for Clinical Microbiology, Department of Microbiology, Immunology and Transplantation, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Els I M Duval
- Department of Adult and Pediatric Intensive Care Medicine, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Antwerp, Belgium
| | - Vincent Fraipont
- Service des Soins Intensifs, CHR Citadelle, Bd du Douzième de Ligne 1, 4000, Liège, Belgium
| | - Dieter Geysels
- Department of Microbiology and Belgian Reference Centre for Invasive β-Hemolytic Streptococci, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Antwerp, Belgium
| | - Greet Hermans
- Medical Intensive Care Unit, Department of General Internal Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Frederik Lahaye
- Department of Adult and Pediatric Intensive Care Medicine, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Antwerp, Belgium
| | - Xavier Mathy
- Service des Soins Intensifs, CHR Citadelle, Bd du Douzième de Ligne 1, 4000, Liège, Belgium
| | - Philippe Meersseman
- Medical Intensive Care Unit, Department of General Internal Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Cécile Meex
- Service de Microbiologie Clinique, University Hospital Liège, Avenue de l'Hôpital, 4000, Liège, Belgium
| | - Jozef Van Herck
- Department of Adult and Pediatric Intensive Care Medicine, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Antwerp, Belgium
| | - Stefanie van Kleef-van Koeveringe
- Department of Microbiology and Belgian Reference Centre for Invasive β-Hemolytic Streptococci, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Antwerp, Belgium
| | - Nathalie Layios
- Department of Intensive Care, University Hospital Liège, Avenue de l'Hôpital, 4000, Liège, Belgium
- Département des Sciences Cliniques, University of Liège, 4000, Liège, Belgium
| | - Joost Wauters
- Medical Intensive Care Unit, Department of General Internal Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
- Laboratory for Clinical Infectious and Inflammatory Disorders, Department of Microbiology, Immunology and Transplantation, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Philippe G Jorens
- Department of Adult and Pediatric Intensive Care Medicine, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Antwerp, Belgium
- Department of Medicine and Health Sciences, Laboratory of Experimental Medicine and Pediatrics (LEMP), University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Antwerp, Belgium
| |
Collapse
|
5
|
De Schuyter K, Boelens J, Messiaen AS, Schelstraete P, Verhasselt B, Huis In't Veld D, Callens S, Sermijn E, Vande Weygaerde Y, Vandendriesche S. Rapid detection of S. pyogenes and S. pneumoniae in pleural fluid for diagnosis of parapneumonic empyema. Eur J Clin Microbiol Infect Dis 2024; 43:195-201. [PMID: 37981632 DOI: 10.1007/s10096-023-04710-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/09/2023] [Indexed: 11/21/2023]
Abstract
The aim of this study was to assess the reliability of rapid antigen detection tests (RADT) for Streptococcus pyogenes (GAS) and Streptococcus pneumoniae on pleural fluid samples for diagnosis of parapneumonic effusion/empyema (PPE) and their potential for improving pathogen identification rates. Sixty-three pleural samples were included from 54 patients on which GAS and S. pneumoniae RADT (BinaxNOW), culture, 16S rRNA PCR, and S. pneumoniae-specific PCR were performed. GAS RADT showed a sensitivity of 95.2% and a specificity of 100%. Pneumococcal RADT showed a sensitivity of 100% and specificity of 88.6%. Both RADT increased the pathogen identification rate in PPE compared to culture.
Collapse
Affiliation(s)
- Kelly De Schuyter
- Department of Internal Medicine and Infectious Diseases, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Jerina Boelens
- Department of Medical Microbiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Anne-Sophie Messiaen
- Department of Medical Microbiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Petra Schelstraete
- Department of Pediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Bruno Verhasselt
- Department of Medical Microbiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Diana Huis In't Veld
- Department of Internal Medicine and Infectious Diseases, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Steven Callens
- Department of Internal Medicine and Infectious Diseases, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Erica Sermijn
- Department of Infectious Diseases, Algemeen Stedelijk Ziekenhuis Aalst, Merestraat 80, 9300, Aalst, Belgium
| | - Yannick Vande Weygaerde
- Department of Respiratory Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Stien Vandendriesche
- Department of Medical Microbiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| |
Collapse
|
6
|
Boyko VV, Tkachenko VV, Sochnieva AL, Kritsak VV. Modern view on the problem of acute pleural empyema surgical treatment. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2024; 77:327-337. [PMID: 38592997 DOI: 10.36740/wlek202402121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
OBJECTIVE Aim: data study on the results of treatment of acute non-specific purulent-destructive pleura diseases with the purpose of further improvement of its results on the basis of improvement of diagnostics, identification of factors of disease prognosis and by implementing differential tactics of surgical treatment with the use of minimally invasive interventions. PATIENTS AND METHODS Materials and Methods: We have studied modern literary sources on the topic of current trends in the treatment of acute pleural empyema and its complications. The studied material is summarized and presented in the form of a literature review in this article. CONCLUSION Conclusions: These issues cannot be considered to be completely solved and require further study. Everything mentioned above dictates the search of new effective methods of the treatment of the mentioned pathology and proves the relevance of the theme. The outlined information highlights the necessity of improvement of surgical tactics in patients with pleural empyema.
Collapse
Affiliation(s)
- Valeriy V Boyko
- KHARKIV NATIONAL MEDICAL UNIVERSITY, KHARKIV, UKRAINE; SI "ZAITSEV INSTITUTE OF GENERAL AND EMERGENCY SURGERY OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE", KHARKIV, UKRAINE
| | - Vladimir V Tkachenko
- EDUCATIONAL AND SCIENTIFIC MEDICAL INSTITUTE OF THE NATIONAL TECHNICAL UNIVERSITY ≪KHARKIV POLYTECHNIC INSTITUTE≫, KHARKIV, UKRAINE
| | - Anastasiia L Sochnieva
- EDUCATIONAL AND SCIENTIFIC MEDICAL INSTITUTE OF THE NATIONAL TECHNICAL UNIVERSITY ≪KHARKIV POLYTECHNIC INSTITUTE≫, KHARKIV, UKRAINE
| | - Vasyl V Kritsak
- SI "ZAITSEV INSTITUTE OF GENERAL AND EMERGENCY SURGERY OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE", KHARKIV, UKRAINE; EDUCATIONAL AND SCIENTIFIC MEDICAL INSTITUTE OF THE NATIONAL TECHNICAL UNIVERSITY ≪KHARKIV POLYTECHNIC INSTITUTE≫, KHARKIV, UKRAINE
| |
Collapse
|
7
|
Forster J, Paul P, Liese J. Current Management of Pediatric Parapneumonic Pleural Effusions and Pleural Empyema. Pediatr Infect Dis J 2023; 42:e407-e410. [PMID: 37566896 DOI: 10.1097/inf.0000000000004061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Affiliation(s)
- Johannes Forster
- From the Institute for Hygiene and Microbiology, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - Pia Paul
- Department of Pediatrics, University Hospital Würzburg, Würzburg, Germany
| | - Johannes Liese
- Department of Pediatrics, University Hospital Würzburg, Würzburg, Germany
| |
Collapse
|
8
|
Chang CD, Thode P, Barrick L. Seven-Year-Old Girl with Fever and Abdominal Pain. Pediatr Rev 2023; 44:S96-S99. [PMID: 37777216 DOI: 10.1542/pir.2022-005912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Affiliation(s)
- Cindy D Chang
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Emergency Medicine, University of Cincinnati Medical Center, Cincinnati, OH
| | - Payton Thode
- Department of Emergency Medicine, Morton Hospital, Taunton, MA
| | - Lindsey Barrick
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, OH
| |
Collapse
|
9
|
Alemayheu G, Lee CSJ, Erdman LK, Wong J, Rutherford C, Smieja M, Khan S, Pernica JM. Children hospitalized with community-acquired pneumonia complicated by effusion: a single-centre retrospective cohort study. BMC Pediatr 2023; 23:181. [PMID: 37072740 PMCID: PMC10113124 DOI: 10.1186/s12887-023-04004-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 04/11/2023] [Indexed: 04/20/2023] Open
Abstract
OBJECTIVES To describe children hospitalized with community-acquired pneumonia complicated by effusion (cCAP). DESIGN Retrospective cohort study. SETTING A Canadian children's hospital. PARTICIPANTS Children without significant medical comorbidities aged < 18 years admitted from January 2015-December 2019 to either the Paediatric Medicine or Paediatric General Surgery services with any pneumonia discharge code who were documented to have an effusion/empyaema using ultrasound. OUTCOME MEASURES Length of stay; admission to the paediatric intensive care unit; microbiologic diagnosis; antibiotic use. RESULTS There were 109 children without significant medical comorbidities hospitalized for confirmed cCAP during the study period. Their median length of stay was 9 days (Q1-Q3 6-11 days) and 35/109 (32%) were admitted to the paediatric intensive care unit. Most (89/109, 74%) underwent procedural drainage. Length of stay was not associated with effusion size but was associated with time to drainage (0.60 days longer stay per day delay in drainage, 95%CI 0.19-1.0 days). Microbiologic diagnosis was more often made via molecular testing of pleural fluids (43/59, 73%) than via blood culture (12/109, 11%); the main aetiologic pathogens were S. pneumoniae (40/109, 37%), S. pyogenes (15/109, 14%), and S. aureus (7/109, 6%). Discharge on a narrow spectrum antibiotic (i.e. amoxicillin) was much more common when the cCAP pathogen was identified as compared to when it was not (68% vs. 24%, p < 0.001). CONCLUSIONS Children with cCAP were commonly hospitalized for prolonged periods. Prompt procedural drainage was associated with shorter hospital stays. Pleural fluid testing often facilitated microbiologic diagnosis, which itself was associated with more appropriate antibiotic therapy.
Collapse
Affiliation(s)
| | - Claire S J Lee
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Laura K Erdman
- Department of Pediatrics, Faculty of Health Sciences, McMaster University, 1280 Main St West, L8S 4K1, Hamilton, ON, Canada
| | - Jacqueline Wong
- Department of Pediatrics, Faculty of Health Sciences, McMaster University, 1280 Main St West, L8S 4K1, Hamilton, ON, Canada
| | - Candy Rutherford
- Hamilton Regional Laboratory Medicine Program, Hamilton, ON, Canada
| | - Marek Smieja
- Department of Pathology and Molecular Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Sarah Khan
- Department of Pediatrics, Faculty of Health Sciences, McMaster University, 1280 Main St West, L8S 4K1, Hamilton, ON, Canada
| | - Jeffrey M Pernica
- Department of Pediatrics, Faculty of Health Sciences, McMaster University, 1280 Main St West, L8S 4K1, Hamilton, ON, Canada.
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
| |
Collapse
|
10
|
Yavuz S, Sherif A, Amirrad M, Sabet K, Hassan M, Abuelreish M, Langawi N, Almanasir M, Francis N. A Retrospective Chart Review of Pediatric Complicated Community-Acquired Pneumonia: An Experience in the Al Qassimi Women and Children Hospital. Cureus 2022; 14:e31119. [DOI: 10.7759/cureus.31119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2022] [Indexed: 11/06/2022] Open
|
11
|
Lee JT, Lin JW, Chen HM, Wang CY, Lu CY, Chang LY, Huang LM. Impact of pneumococcal conjugate vaccination on hospitalized childhood pneumonia in Taiwan. Pediatr Res 2022; 92:1161-1167. [PMID: 34937875 DOI: 10.1038/s41390-021-01772-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 09/11/2021] [Accepted: 09/17/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND A national 13-valent pneumococcal conjugate vaccine (PCV13) catch-up program among children aged 2-5 years in 2013, before routine infant immunization in 2015, successfully reduced serotype 19A-related invasive pneumococcal diseases in Taiwan. We aimed to investigate its impact on hospitalized childhood pneumonia. METHODS We analyzed the National Health Insurance Research Database, 2001-2017, for hospitalized children aged <18 years with the diagnoses of all-cause pneumonia, lobar/pneumococcal pneumonia, and pneumococcal parapneumonic diseases. The study period was divided into 2001-2005 (pre-PCV), 2006-2012 (private sectors), and 2013-2017 (universal PCV13 vaccination). RESULTS On pneumococcal parapneumonic diseases, the national PCV13 vaccination program was associated with an immediate decline in 2-4-year-old children and significant decreasing trends in all ages. The incidence rate ratios of 2016-2017/2011-2012 were 0.16 (95% confidence interval [CI], 0.06-0.40) and 0.18 (95% CI, 0.13-0.23) in children aged < 2 and 2-4 years, respectively. We observed an increase of lobar/pneumococcal pneumonia cases after an early decline. The intensive/invasive medical needs and the fatality of all-cause pneumonia decreased significantly in children of all ages. CONCLUSIONS Pneumococcal parapneumonic diseases and the disease burden of lobar/pneumococcal pneumonia and lower respiratory tract infections declined after the national PCV13 vaccination program. IMPACT The impact study of the PCV13 immunization program on childhood pneumonia in Asian countries remained limited. The unique PCV13 immunization program in Taiwan, catch-up before primary infantile series, reduced severe childhood pneumococcal pneumonia at 5 years post PCV13. The intensive and invasive medical needs and fatality of all-cause pneumonia decreased significantly in children of all ages. We observed an increase in lobar/pneumococcal pneumonia after an early decline.
Collapse
Affiliation(s)
- Jian-Te Lee
- National Taiwan University Hospital, Yunlin Branch, Yunlin, Taiwan
| | - Jou-Wei Lin
- National Taiwan University Hospital, Yunlin Branch, Yunlin, Taiwan
| | | | - Chen-Yu Wang
- National Taiwan University Hospital, Yunlin Branch, Yunlin, Taiwan
| | - Chun-Yi Lu
- National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Luan-Yin Chang
- National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Li-Min Huang
- National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| |
Collapse
|
12
|
Silva-Costa C, Gomes-Silva J, Pinho MD, Friães A, Ramirez M, Melo-Cristino J. Continued Vaccine Breakthrough Cases of Serotype 3 Complicated Pneumonia in Vaccinated Children, Portugal (2016-2019). Microbiol Spectr 2022; 10:e0107722. [PMID: 35862941 PMCID: PMC9431508 DOI: 10.1128/spectrum.01077-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/07/2022] [Indexed: 11/20/2022] Open
Abstract
We previously reported that despite the use of pneumococcal conjugate vaccines (PCVs), vaccine serotypes remained important causes of pneumonia with pleural effusion and empyema (pediatric complicated pneumococcal pneumonia [PCPP]). We cultured and performed PCR on 174 pleural fluid samples recovered from pediatric patients in Portugal from 2016 to 2019 to identify and serotype Streptococcus pneumoniae. Most PCPP cases (n = 87/98) were identified by PCR only. Serotypes 3 (67%), 14, and 8 (5% each) were the most frequent. Vaccine breakthrough cases were seen among age-appropriately, 13-valent, PCV vaccinated children (median: 3 years, range: 17 months to 7 years), mostly with serotype 3 (n = 27) but also with serotypes 14 and 19A (n = 2 each). One breakthrough was seen with serotype 14 in an age-appropriately, 10-valent, PCV-vaccinated child and another with serotype 3 in a child to whom the 23-valent polysaccharide vaccine was administered. While the relative risk of serotype 1 PCPP decreased almost 10-fold from the period of 2010 to 2015 to the period of 2016 to 2019 (relative risk [RR] = 0.106), that of serotype 3 PCPP almost doubled (RR = 1.835). Our data highlight the importance of molecular diagnostics in identifying PCPP and document the continued importance of serotype 3 PCPP, even when PCV13 use with almost universal coverage could be expected to reduce exposure to this serotype. IMPORTANCE The use of conjugate vaccines against Streptococcus pneumoniae in children has led to substantial reductions in pneumococcal invasive disease. However, the reductions seen in each of the 13 serotypes currently included in the highest-valency vaccine approved for use in children (PCV13), were not the same. It is becoming clear that most vaccine breakthroughs worldwide involve serotype 3 and are frequently associated with complicated pneumonia cases, often with empyema or pleural effusion. Here, we show that despite almost universal PCV13 use, which would be expected to reduce vaccine serotype circulation and further reinforce vaccine direct protection, pneumococci and serotype 3 remain the major causes of pediatric complicated pneumonia. Molecular methods are essential to identify and serotype pneumococci in these cases, which frequently reflect vaccine breakthroughs. A broader use of molecular diagnostics will be essential to determine the role of this important serotype in the context of PCV13 use in different geographic regions.
Collapse
Affiliation(s)
- Catarina Silva-Costa
- Instituto de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Joana Gomes-Silva
- Instituto de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Marcos D. Pinho
- Instituto de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Ana Friães
- Instituto de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Mário Ramirez
- Instituto de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - José Melo-Cristino
- Instituto de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| |
Collapse
|
13
|
Moral L, Toral T, Marco N, Clavijo A, Canals F, Forniés MJ, González MC, Moral J, Márquez M, Lucas R, Caballero M, Huertas AM, García-Avilés B, Belda M. Epidemiology of pediatric parapneumonic pleural effusion during 13-valent pneumococcal conjugate vaccine implementation. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2022:S2529-993X(22)00175-7. [PMID: 35985928 DOI: 10.1016/j.eimce.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 01/07/2022] [Accepted: 01/17/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION The reported incidence of parapneumonic pleural effusion, including empyema, has shown fluctuations in the last decades. It has been related to the implementation of different types of conjugate pneumococcal vaccines. METHODS We have retrospectively reviewed data from all 10 public hospitals in Alicante Province (Spain) covering a population of 279,000 children under 15 years of age, between 2010 and 2018. Effusions less than 10 mm (PE-) and those of 10 mm or more (PE+) were separated. RESULTS A total of 366 episodes of parapneumonic pleural effusion have been analyzed, 178 PE- (48.6%) and 188 PE+ (51.4%), with a median age of 4 years (interquartile range: 2-7 years) and marked seasonality with the maximum in winter and the minimum in summer. A culture proven bacterial agent was identified in 34 patients (9.3%), mainly Streptococcus pneumoniae (24 patients) followed by Streptococcus pyogenes (7 patients). The most frequent S. pneumoniae serotype was 19A (6 patients) and 3 vaccine failures were observed. The mean annual incidence rate was 14.3 cases per 100,000 children under 15 years of age (7.0 for PE- and 7.3 for PE+). No significant changes were observed in incidence over time, but noticeable differences in incidence were observed in different health departments. CONCLUSIONS We have not found temporal variations in incidence of parapneumonic effusion despite the implementation of the 13-valent pneumococcal conjugate vaccine. The unexplained disparity in incidence between close departments is noteworthy.
Collapse
Affiliation(s)
- Luis Moral
- Unidad de Neumología y Alergología Pediátrica, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain.
| | - Teresa Toral
- Unidad de Neumología y Alergología Pediátrica, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Nuria Marco
- Servicio de Pediatría, Hospital Vega Baja, Orihuela, Alicante, Spain
| | - Agustín Clavijo
- Servicio de Pediatría, Hospital Marina Baixa, Villajoyosa, Alicante, Spain
| | - Francisco Canals
- Servicio de Pediatría, Hospital General Universitario de Elche, Elche, Alicante, Spain
| | - María José Forniés
- Servicio de Pediatría, Hospital Universitario Virgen de la Salud, Elda, Alicante, Spain
| | | | - Jorge Moral
- Facultad de Medicina, Universidad Miguel Hernández, Sant Joan d'Alacant, Alicante, Spain
| | - Marta Márquez
- Servicio de Pediatría, Hospital General Universitario de Alicante, Alicante, Spain
| | - Raquel Lucas
- Servicio de Pediatría, Hospital Marina Salud, Denia, Alicante, Spain
| | - María Caballero
- Servicio de Pediatría, Hospital Universitario del Vinalopó, Elche, Alicante, Spain
| | - Ana María Huertas
- Servicio de Pediatría, Hospital Universitario del Vinalopó, Elche, Alicante, Spain
| | - Belén García-Avilés
- Servicio de Pediatría, Hospital Clínico Universitario de Sant Joan d'Alacant, Sant Joan d'Alacant, Alicante, Spain
| | - Mónica Belda
- Servicio de Pediatría, Hospital Virgen de los Lirios, Alcoy, Alicante, Spain
| |
Collapse
|
14
|
Güneylioğlu MM, Güngör A, Göktuğ A, Üner Ç, Bodur İ, Yaradılmış RM, Öztürk B, Şen ZS, Tuygun N. Evaluation of the efficiency of the systemic immune-inflammation index in differentiating parapneumonic effusion from empyema. Pediatr Pulmonol 2022; 57:1625-1630. [PMID: 35420252 DOI: 10.1002/ppul.25926] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/10/2022] [Accepted: 04/04/2022] [Indexed: 11/09/2022]
Abstract
AIM To evaluate the effectiveness of the systemic immune-inflammation index (SII) and other biomarkers in distinguishing parapneumonic effusion (PPE) and empyema. METHODS Patients who were thought to have pleural effusion secondary to pneumonia in the pediatric emergency department (PED) between 2004 and 2021 were retrospectively evaluated. The patients were divided into two groups as empyema and PPE. The efficacy of infection markers in predicting empyema was compared. RESULTS Fifty-nine patients (59.3% male) were included in the study. Forty-three (72.9%) patients were in the PPE and 16 (27.1%) were in the empyema group. Length of hospital stay and pleural fluid thickness measured with thoracic ultrasonography were significantly higher in the empyema group (p = 0.018 and p = 0.002, respectively). The mean SII was 1902.73 ± 1588.87 in PPE patients, while it was 6899.98 ± 6678 in empyema patients (p = 0.009). C-reactive protein (CRP), white blood cell (WBC) count, absolute neutrophil count (ANC), and neutrophil-lymphocyte ratio (NLR) were significantly higher in the empyema group; absolute lymphocyte count (ALC) and lymphocyte-monocytes ratio (LMR) were significantly lower than the PPE group. When the best cut-off values of inflammation markers are determined according to the area under the curve, the highest odds ratios suggesting empyema were found in SII, LMR, CRP, and ANC, respectively. CONCLUSION Inflammation markers can be useful in predicting empyema. The best markers were found to be SII, LMR, CRP, and ANC. High SII is one of the practical diagnostic markers that can be used differentiate empyema from PPE in PED.
Collapse
Affiliation(s)
- Muhammed M Güneylioğlu
- Department of Pediatric Emergency Medicine, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Ali Güngör
- Department of Pediatric Emergency Medicine, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Aytaç Göktuğ
- Department of Pediatric Emergency Medicine, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Çiğdem Üner
- Department of Pediatric Radiology, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - İlknur Bodur
- Department of Pediatric Emergency Medicine, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Raziye M Yaradılmış
- Department of Pediatric Emergency Medicine, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Betül Öztürk
- Department of Pediatric Emergency Medicine, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Zeynep S Şen
- Department of Pediatric Infectious Diseases, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Nilden Tuygun
- Department of Pediatric Emergency Medicine, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| |
Collapse
|
15
|
Subhi R, Gelbart B, Ching N, Thompson J, Osowicki J, Rozen TH, Shanthikumar S, Teague W, Duke T. Characteristics, management and changing incidence of children with empyema in a paediatric intensive care unit. J Paediatr Child Health 2022; 58:1046-1052. [PMID: 35191560 PMCID: PMC9305239 DOI: 10.1111/jpc.15905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 01/06/2022] [Accepted: 01/26/2022] [Indexed: 11/29/2022]
Abstract
AIM Paediatric intensive care unit (PICU) admissions for empyema increased following the 13-valent pneumococcal conjugate vaccine (PCV13). We describe the clinical characteristics, management and outcomes for children with empyema and compare incidence before and after PCV13. METHODS Retrospective study of patients <18 years admitted to The Royal Children's Hospital Melbourne PICU with empyema between January 2016 and July 2019. We investigated the incidence of empyema during two time periods: 2007-2010 (pre-PCV13) and 2016-2019 (post-PCV13). RESULTS Seventy-one children (1.9% of all PICU admissions) were admitted to PICU with empyema between 2016 and 2019. Sixty-one (86%) had unilateral disease, 11 (16%) presented with shock and 44 (62%) were ventilated. Streptococcus pneumoniae and group A Streptococcus were the most commonly identified pathogens. Forty-five (63%) were managed with video-assisted thoracoscopic surgery (VATS). There was a 31% reduction in empyema hospitalisations as a proportion of all hospitalisations (IRR 0.69, 95% CI 0.59-0.8), but a 2.8-fold increase in empyema PICU admissions as a proportion of all PICU admissions (95% CI 2.2-3.5, P < 0.001). For the PICU cohort, this was accompanied by reduction in PIM2 probability of death (median 1% vs. 1.9%, P = 0.02) and duration of intubation (median 69 h vs. 126.5 h, P = 0.045). CONCLUSIONS In children with empyema in PICU 62% required ventilation, 16% had features of shock and 63% received VATS. Empyema admissions, as a proportion of all PICU admissions, increased in the era post-PCV13 compared to pre-PCV13 despite no increase in illness severity at admission.
Collapse
Affiliation(s)
- Rami Subhi
- Paediatric Intensive Care UnitRoyal Children's HospitalMelbourneVictoriaAustralia,Infection and ImmunityMurdoch Children's Research InstituteMelbourneVictoriaAustralia,Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia
| | - Ben Gelbart
- Paediatric Intensive Care UnitRoyal Children's HospitalMelbourneVictoriaAustralia,Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia,Clinical SciencesMurdoch Children's Research InstituteMelbourneVictoriaAustralia
| | - Natasha Ching
- Microbiology, Department of PathologyLaboratory ServicesMelbourneVictoriaAustralia,Infection and ImmunityMonash Children's HospitalMelbourneVictoriaAustralia,General PaediatricsMonash Children's HospitalMelbourneVictoriaAustralia,Department of PaediatricsMonash UniversityMelbourneVictoriaAustralia
| | - Jenny Thompson
- Paediatric Intensive Care UnitRoyal Children's HospitalMelbourneVictoriaAustralia
| | - Joshua Osowicki
- Infection and ImmunityMurdoch Children's Research InstituteMelbourneVictoriaAustralia,Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia,Infectious Diseases Unit, Department of General MedicineRoyal Children's HospitalMelbourneVictoriaAustralia
| | - Thomas H Rozen
- Paediatric Intensive Care UnitRoyal Children's HospitalMelbourneVictoriaAustralia,Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia
| | - Shivanthan Shanthikumar
- Infection and ImmunityMurdoch Children's Research InstituteMelbourneVictoriaAustralia,Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia,Respiratory and Sleep MedicineRoyal Children's HospitalMelbourneVictoriaAustralia
| | - Warwick Teague
- Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia,Clinical SciencesMurdoch Children's Research InstituteMelbourneVictoriaAustralia,Department of Paediatric Surgery, Trauma ServiceRoyal Children's HospitalMelbourneVictoriaAustralia
| | - Trevor Duke
- Paediatric Intensive Care UnitRoyal Children's HospitalMelbourneVictoriaAustralia,Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia,Discipline of Child Health, School of Medicine and Health SciencesUniversity of Papua New GuineaPort MoresbyPapua New Guinea
| |
Collapse
|
16
|
Aguilera-Alonso D, Kirchschläger Nieto S, Ara Montojo MF, Sanz Santaeufemia FJ, Saavedra-Lozano J, Soto B, Caminoa MB, Berzosa A, Prieto Tato L, Cercenado E, Tagarro A, Molina Arana D, Alonso Sanz M, Romero Gómez MP, Chaves Sánchez F, Baquero-Artigao F. Staphylococcus aureus Community-acquired Pneumonia in Children After 13-Valent Pneumococcal Vaccination (2008-2018): Epidemiology, Clinical Characteristics and Outcomes. Pediatr Infect Dis J 2022; 41:e235-e242. [PMID: 35333816 DOI: 10.1097/inf.0000000000003503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The epidemiology of community-acquired pneumonia (CAP) has changed, influenced by sociosanitary conditions and vaccination status. We aimed to analyze the recent epidemiology of bacterial CAP in hospitalized children in a setting with high pneumococcal vaccination coverage and to describe the clinical characteristics of pediatric Staphylococcus aureus CAP. METHODS Children <17 years old hospitalized from 2008 to 2018 with bacterial CAP in 5 tertiary hospitals in Spain were included. Cases with pneumococcal CAP were randomly selected as comparative group following a case-control ratio of 2:1 with S. aureus CAP. RESULTS A total of 313 bacterial CAP were diagnosed: Streptococcus pneumoniae CAP (n = 236, 75.4%), Streptococcus pyogenes CAP (n = 43, 13.7%) and S. aureus CAP (n = 34, 10.9%). Throughout the study period, the prevalence of S. pyogenes increased (annual percentage change: +16.1% [95% CI: 1.7-32.4], P = 0.031), S. pneumoniae decreased (annual percentage change: -4.4% [95 CI: -8.8 to 0.2], P = 0.057) and S. aureus remained stable. Nine isolates of S. aureus (26.5%) were methicillin-resistant. Seventeen cases (50%) with S. aureus CAP had some pulmonary complication and 21 (61.7%) required intensive care. S. pneumoniae CAP showed a trend toward higher prevalence of pulmonary complications compared with S. aureus CAP (69.1% vs. 50.0%, P = 0.060), including higher frequency of pulmonary necrosis (32.4% vs. 5.9%, P = 0.003). CONCLUSIONS The incidence of S. aureus CAP in children remained stable, whereas the prevalence of pneumococcal CAP decreased and S. pyogenes CAP increased. Patients with S. aureus presented a high frequency of severe outcomes, but a lower risk of pulmonary complications than patients with S. pneumoniae.
Collapse
Affiliation(s)
- David Aguilera-Alonso
- From the Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Unidad de Investigación Materno-Infantil Fundación Familia Alonso (UDIMIFFA), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- CIBER en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | | | | | | | - Jesús Saavedra-Lozano
- From the Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Unidad de Investigación Materno-Infantil Fundación Familia Alonso (UDIMIFFA), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- CIBER en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Beatriz Soto
- Department of Pediatrics, Hospital de Getafe, Madrid, Spain
| | | | - Arantxa Berzosa
- Department of Pediatrics, Hospital Clinico San Carlos, Madrid, Spain
| | - Luis Prieto Tato
- Department of Pediatric Infectious Diseases, Hospital Universitario Doce de Octubre, Madrid, Spain
| | - Emilia Cercenado
- Department of Microbiology, Hospital General Universitario Gregorio Marañón, CIBERES, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
| | - Alfredo Tagarro
- Department of Pediatrics, Hospital Infanta Sofía, Madrid, Spain
| | | | | | - María Pilar Romero Gómez
- CIBER en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Department of Microbiology, Hospital Universitario La Paz, Madrid, Spain
| | | | | |
Collapse
|
17
|
Loto‐Aso E, Howie SRC, Grant CC. Childhood pneumonia in New Zealand. J Paediatr Child Health 2022; 58:752-757. [PMID: 35244959 PMCID: PMC9311843 DOI: 10.1111/jpc.15941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 02/14/2022] [Accepted: 02/21/2022] [Indexed: 11/30/2022]
Abstract
While deaths from pneumonia during childhood in New Zealand (NZ) are now infrequent, childhood pneumonia remains a significant cause of morbidity. In this viewpoint, we describe pneumonia epidemiology in NZ and identify modifiable risk factors. During recent decades, pneumonia hospitalisation rates decreased, attributable in part to inclusion of pneumococcal conjugate vaccine in NZ's immunisation schedule. Irrespective of these decreases, pneumonia hospitalisation rates are four times higher for Pacific and 60% higher for Māori compared with children of other ethnic groups. Consistent with other developed countries, hospitalisation rates for pneumonia with pleural empyema increased in NZ during the 2000s. Numerous factors contribute to childhood pneumonia acquisition, hospitalisation and morbidity in NZ include poor quality living environments, malnutrition during pregnancy and early childhood, incomplete and delayed vaccination during pregnancy and childhood and variable primary and secondary care management. To reduce childhood pneumonia disease burden, interventions should focus on addressing modifiable risk factors for pneumonia. These include using non-polluting forms of household heating; decreasing cigarette smoke exposure; reducing household acute respiratory infection transmission; improving dietary nutritional content and nutrition during pregnancy and early childhood; breastfeeding promotion; vaccination during pregnancy and childhood and improving the quality of and decreasing the variance in primary and secondary care management of pneumonia.
Collapse
Affiliation(s)
- Eseta Loto‐Aso
- Kidz First Neonatal CareCounties Manukau District Health BoardAucklandNew Zealand
| | - Stephen RC Howie
- Department of Paediatrics: Child & Youth HealthUniversity of AucklandAucklandNew Zealand,Child, Women and Family ServicesWaitematā District Health BoardAucklandNew Zealand
| | - Cameron C Grant
- Child, Women and Family ServicesWaitematā District Health BoardAucklandNew Zealand,General Paediatrics, Starship Children's HospitalAuckland District Health BoardAucklandNew Zealand
| |
Collapse
|
18
|
Forster J, Kohlmorgen B, Haas J, Weis P, Breunig L, Turnwald D, Mizaikoff B, Schoen C. A streamlined method for the fast and cost-effective detection of bacterial pathogens from positive blood cultures for the BacT/ALERT blood culture system using the Vitek MS mass spectrometer. PLoS One 2022; 17:e0267669. [PMID: 35482712 PMCID: PMC9049335 DOI: 10.1371/journal.pone.0267669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 04/12/2022] [Indexed: 11/25/2022] Open
Abstract
Background and objective Prompt pathogen identification of blood stream infections is essential to provide appropriate antibiotic treatment. Therefore, the objective of this prospective single centre study was to establish an inexpensive, fast and accurate protocol for bacterial species identification with SDS protein-extraction directly from BacT/Alert® blood culture (BC) bottles by VitekMS®. Results Correct species identification was obtained for 198/266 (74.4%, 95%-CI = [68.8%, 79.6%]) of pathogens. The protocol was more successful in identifying 87/96 (91.4%, 95%-CI = [83.8%, 93.2%]) gram-negative bacteria than 110/167 (65.9%, 95%-CI = [58.1%, 73.0%]) gram-positive bacteria. The hands-on time for sample preparation and measurement was about 15 min for up to five samples. This is shorter than for most other protocols using a similar lysis-centrifugation approach for the combination of BacT/Alert® BC bottles and the Vitek® MS mass spectrometer. The estimated costs per sample were approx. 1.80€ which is much cheaper than for commercial kits. Conclusion This optimized protocol allows for accurate identification of bacteria directly from blood culture bottles for laboratories equipped with BacT/Alert® blood culture bottles and VitekMS® mass spectrometer.
Collapse
Affiliation(s)
- Johannes Forster
- Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
- * E-mail:
| | - Britta Kohlmorgen
- Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
- Institute of Hygiene and Environmental Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Julian Haas
- Hahn-Schickard- Society for Applied Research, Ulm, Germany
| | - Philipp Weis
- Department of Internal Medicine I, Caritas-Krankenhaus Bad Mergentheim, Bad Mergentheim, Germany
| | - Lukas Breunig
- Department of Internal Medicine – Cardiology, DRK Klinikum Berlin Westend, Berlin, Germany
| | - Doris Turnwald
- Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
| | - Boris Mizaikoff
- Hahn-Schickard- Society for Applied Research, Ulm, Germany
- Institute of Analytical and Bioanalytical Chemistry, Ulm University, Ulm, Germany
| | - Christoph Schoen
- Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
| |
Collapse
|
19
|
Dworsky ZD, Lee B, Ramchandar N, Rungvivatjarus T, Coufal NG, Bradley JS. Impact of Cell-Free Next-Generation Sequencing on Management of Pediatric Complicated Pneumonia. Hosp Pediatr 2022; 12:377-384. [PMID: 35233619 DOI: 10.1542/hpeds.2021-006361] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Community-acquired pneumonia (CAP) is common in pediatrics. More severe complicated CAP (cCAP) requires broad-spectrum empirical therapy. Cell-free plasma next-generation sequencing (cfNGS), a DNA-based diagnostic tool, could be used to guide therapy. We retrospectively compared the pathogen identification rate of cfNGS to that of standard culture methods and assessed the impact of cfNGS on antibiotic therapy in children hospitalized for cCAP. METHODS We conducted a retrospective review of children aged 3 months to 18 years hospitalized for cCAP with cfNGS results from January 24, 2018, to December 31, 2020. We compared the positivity rate of conventional microbiologic diagnostic testing with that of cfNGS and the impact on clinical management, including changes in antibiotic therapy. RESULTS We identified 46 hospitalized children with cCAP with cfNGS results. Of these children, 34 also had blood cultures (1 positive for pathogen; 3%) and 37 had pleural fluid cultures (10 positive for pathogen; 27%). Of the 46 children, positive cfNGS testing results were positive for pathogen in 45 (98%), with the causative pathogen identified in 41 (89%). cfNGS was the only method for pathogen identification in 32 children (70%). cfNGS results changed management in 36 (78%) of 46 children, with the antibiotic spectrum narrowed in 29 (81%). CONCLUSIONS cfNGS provided a higher diagnostic yield in our pediatric cCAP cohort compared with conventional diagnostic testing and affected management in 78% of children. Prospective studies are needed to better characterize the clinical outcome, cost-effectiveness, and antimicrobial stewardship benefits of cfNGS in pediatric cCAP.
Collapse
Affiliation(s)
- Zephyr D Dworsky
- Department of Pediatrics, University of California, San Diego, San Diego, California.,Rady Children's Hospital, San Diego, California
| | - Begem Lee
- Department of Pediatrics, University of California, San Diego, San Diego, California.,Rady Children's Hospital, San Diego, California
| | - Nanda Ramchandar
- Department of Pediatrics, University of California, San Diego, San Diego, California.,Rady Children's Hospital, San Diego, California.,Department of Pediatrics, Naval Medical Center San Diego, San Diego, California
| | - Tiranun Rungvivatjarus
- Department of Pediatrics, University of California, San Diego, San Diego, California.,Rady Children's Hospital, San Diego, California
| | - Nicole G Coufal
- Department of Pediatrics, University of California, San Diego, San Diego, California.,Rady Children's Hospital, San Diego, California
| | - John S Bradley
- Department of Pediatrics, University of California, San Diego, San Diego, California.,Rady Children's Hospital, San Diego, California
| |
Collapse
|
20
|
Epidemiología del derrame pleural paraneumónico en la infancia durante la implementación de la vacuna antineumocócica conjugada de 13 serotipos. Enferm Infecc Microbiol Clin 2022. [DOI: 10.1016/j.eimc.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
21
|
Lüdemann M, Sulastyanto S, Raab P, Schoen C, Rudert M. Periprosthetic joint infection: Comparison of automated multiplex-PCR Unyvero i60 ITI cartridge system with bacterial culture and real-time PCR. Technol Health Care 2022; 30:1005-1015. [DOI: 10.3233/thc-213248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: In the past, various efforts have been made to investigate diagnostic tools for periprosthetic-joint-infection (PJI). It is little-known about the diagnostic utility of polymerase-chain-reaction (PCR) in this context, especially concerning the role of multiplex-PCR assays comparing with conventional tissue culture. OBJECTIVE: Evaluation of an automated-multiplex-PCR cartridge system for patients with suspicion of PJI in comparison with conventional microbiological culture and 16S-rDNA-PCR. METHODS: On suspicion of PJI synovial fluid specimen were taken preoperatively or periprosthetic tissue was collected intraoperatively. Microbiological analysis included conventional culture, 16S-rDNA-PCR and automated-multiplex-PCR (Unyvero-i60-ITI®). The European-Bone-and-Joint-Infection-Society (EBJIS) criteria were used for PJI diagnosis. Positive and negative percent agreement was calculated. Total percentage agreement and Cohen’s kappa coefficient were calculated. Sensitivity, specificity and positive predictive value of conventional culture, 16S-rDNA-PCR and multiplex-PCR were calculated. Ten specimens of proved PJI were used as control group. RESULTS: Fifty specimen were suitable for culture. 14 (28%) were classified as PJI, 36 (72%) were aseptic. Coagulase-negative staphylococci was the most frequent detected pathogen. Concordance-rate between mPCR and culture results was 75.6% with a Cohen’s kappa of 0.28. Concordance-rate between mPCR and 16S-rDNA was 82.9%, Cohen’s kappa was 0.13. Concordance analysis between culture results and 16S-rDNA lead to a concordance-rate of 88.9%. Cohen’s kappa was calculated with 0.6. With regard to the microbiological culture as reference, sensitivity of the mPCR was 0.33 and specificity was 0.91. Sensitivity and specificity of the 16S-rDNA-PCR was 0.55 and 0.97. The positive predictive value was 0.57 for the mPCR and 0.83 for the 16S-rDNA-PCR. CONCLUSIONS: Due to fair agreement between mPCR and conventional microbiological culture, the tested multiplex-PCR could be an additional instrument for the detection of PJI but is not superior over the conventional culture.
Collapse
Affiliation(s)
- Martin Lüdemann
- Department of Orthopaedic Surgery, University of Wuerzburg, Wuerzburg, Germany
| | - Saskia Sulastyanto
- Department of Orthopaedic Surgery, University of Wuerzburg, Wuerzburg, Germany
| | - Peter Raab
- Department of Orthopaedic Surgery, University of Wuerzburg, Wuerzburg, Germany
| | - Christoph Schoen
- Institute for Hygiene and Microbiology, University of Wuerzburg, Wuerzburg, Germany
| | - Maximilian Rudert
- Department of Orthopaedic Surgery, University of Wuerzburg, Wuerzburg, Germany
| |
Collapse
|
22
|
Otheo E, Rodríguez M, Moraleda C, Domínguez-Rodríguez S, Martín MD, Herreros ML, Vázquez C, Folgueira MD, Pérez-Rivilla A, Jensen J, López A, Berzosa A, Sanz de Santaeufemia FJ, Jiménez AB, Sainz T, Llorente M, Santos M, Garrote E, Muñoz C, Sánchez P, Illán M, Coca A, Barrios A, Pacheco M, Arquero C, Gutiérrez L, Epalza C, Rojo P, Serna-Pascual M, Mota I, Moreno S, Galán JC, Tagarro A. Viruses and Mycoplasma pneumoniae are the main etiological agents of community-acquired pneumonia in hospitalized pediatric patients in Spain. Pediatr Pulmonol 2022; 57:253-263. [PMID: 34633153 DOI: 10.1002/ppul.25721] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 09/22/2021] [Accepted: 10/08/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To describe the etiology of community-acquired pneumonia (CAP) in hospitalized children in Spain and analyze the predictors of the etiology. HYPOTHESIS The different etiological groups of pediatric CAP are associated with different clinical, radiographic, and analytical data. DESIGN Observational, multicenter, and prospective study. PATIENT SELECTION This study included children aged 1 month to 17 years with CAP, who were hospitalized between April 2012 and May 2019. METHODS An extensive microbiological workup was performed. The clinical, radiographic, and analytical parameters were analyzed for three etiological groups. RESULTS Among the 495 children included, at least one causative pathogen was identified in 262 (52.9%): pathogenic viruses in 155/262 (59.2%); atypical bacteria (AB), mainly Mycoplasma pneumonia, in 84/262 (32.1%); and typical bacteria (TyB) in 40/262 (15.3%). Consolidation was observed in 89/138 (64.5%) patients with viral CAP, 74/84 (88.1%) with CAP caused by AB, and 40/40 (100%) with CAP caused by TyB. Para-pneumonic pleural effusion (PPE) was observed in 112/495 (22.6%) patients, of which 61/112 (54.5%) presented a likely causative pathogen: viruses in 12/61 (19.7%); AB in 23/61 (37.7%); and TyB in 26/61 (42.6%). Viral etiology was significantly frequent in young patients and in those with low oxygen saturation, wheezing, no consolidation, and high lymphocyte counts. CAP patients with AB as the etiological agent had a significantly longer and less serious course as compared to those with other causative pathogens. CONCLUSIONS Viruses and M. pneumoniae are the main causes of pediatric CAP in Spain. Wheezing, young age, and no consolidation on radiographs are indicative of viral etiology. Viruses and AB can also cause PPE. Since only a few cases can be directly attributed to TyB, the indications for antibiotics must be carefully considered in each patient.
Collapse
Affiliation(s)
- Enrique Otheo
- Department of Pediatrics, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain
| | - Mario Rodríguez
- Department of Microbiology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal para la Investigación Sanitaria (IRYCIS), Madrid, Spain.,Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Cinta Moraleda
- Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Madrid, Spain.,RITIP (Translational Research Network in Pediatric Infectious Diseases), Madrid, Spain.,Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain.,Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain
| | - Sara Domínguez-Rodríguez
- Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Madrid, Spain.,RITIP (Translational Research Network in Pediatric Infectious Diseases), Madrid, Spain.,Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain
| | - María D Martín
- Department of Microbiology, Laboratorio BR Salud, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - María L Herreros
- Department of Pediatrics, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - Carmen Vázquez
- Department of Pediatrics, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain
| | - María D Folgueira
- Department of Microbiology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain
| | - Alfredo Pérez-Rivilla
- Department of Microbiology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain
| | - Julia Jensen
- Department of Pediatrics, Hospital Infanta Cristina , Parla, Madrid, Spain
| | - Agustín López
- Department of Pediatrics, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Arantxa Berzosa
- Department of Pediatrics, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | | | - Ana B Jiménez
- Department of Pediatrics, Fundación Jiménez Díaz, Madrid, Spain
| | - Talía Sainz
- RITIP (Translational Research Network in Pediatric Infectious Diseases), Madrid, Spain.,Department of Pediatrics, Infectious and Tropical Diseases, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPAZ), Madrid, Spain
| | - Marta Llorente
- Department of Pediatrics, Hospital Universitario del Sureste, Arganda del Rey, Madrid, Spain
| | - Mar Santos
- RITIP (Translational Research Network in Pediatric Infectious Diseases), Madrid, Spain.,Pediatric Infectious Diseases Unit, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Elisa Garrote
- Department of Pediatrics, Hospital Universitario Basurto, Bilbao, Vizcaya, Spain
| | - Cristina Muñoz
- Department of Pediatrics, Hospital General de Villalba, Villalba, Madrid, Spain
| | - Paula Sánchez
- Pediatric Infectious Diseases, Immunology and Rheumatology Unit, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain
| | - Marta Illán
- Department of Pediatrics, Hospital Clínico San Carlos, Madrid, Spain
| | - Ana Coca
- Pediatric Intensive Care Unit, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Ana Barrios
- Department of Pediatrics, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - Mónica Pacheco
- Department of Pediatrics, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - Carmen Arquero
- Department of Pediatrics, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - Lourdes Gutiérrez
- Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Madrid, Spain.,RITIP (Translational Research Network in Pediatric Infectious Diseases), Madrid, Spain.,Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain
| | - Cristina Epalza
- Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Madrid, Spain.,RITIP (Translational Research Network in Pediatric Infectious Diseases), Madrid, Spain.,Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain.,Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain
| | - Pablo Rojo
- Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Madrid, Spain.,RITIP (Translational Research Network in Pediatric Infectious Diseases), Madrid, Spain.,Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain.,Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain.,Department of Pediatrics, Universidad Complutense de Madrid, Madrid, Spain
| | - Miquel Serna-Pascual
- Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Madrid, Spain.,RITIP (Translational Research Network in Pediatric Infectious Diseases), Madrid, Spain.,Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain
| | - Inmaculada Mota
- Department of Radiology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Santiago Moreno
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain
| | - Juan C Galán
- Department of Microbiology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal para la Investigación Sanitaria (IRYCIS), Madrid, Spain.,Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Alfredo Tagarro
- Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Madrid, Spain.,RITIP (Translational Research Network in Pediatric Infectious Diseases), Madrid, Spain.,Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain.,Department of Pediatrics, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain.,Pediatrics Research Group, Universidad Europea de Madrid, Madrid, Spain
| | | |
Collapse
|
23
|
Abstract
BACKGROUND Pediatric parapneumonic effusion/ pleural empyema (PPE/PE) is a severe infectious condition, and its management should be guided by local epidemiology and the patient's medical history. This survey aimed to determine the clinical and bacteriologic features of PPE/PE in Japan. METHODS A nationwide retrospective questionnaire survey was conducted, targeting 159 pediatric specialist training medical facilities for inpatients ≤18 years of age who were admitted for PPE/PE between January 2007 and December 2016. RESULTS Valid responses were obtained from 122 facilities, and 96 patients were identified from 38 facilities. The median age (interquartile range) was 2.7 (0.8-7.8) years. Overall, 60 (63 %) patients were men and 49 (51%) had comorbidities. The causative bacteria were identified in 59% of patients by culture except in one case identified using PCR. Streptococcus pyogenes (16%), Staphylococcus aureus (14%) and Streptococcus pneumoniae (13%) were the major pathogens. Carbapenems were administered to 34% of patients without comorbidities. Chest tube drainage was performed in 71%, intrapleural fibrinolytic therapy in 9.4%, surgery in 25% and mechanical ventilation in 29% of the patients. Five patients (5.2%) had complications and one (1.1%) had sequelae, but all patients (100%) survived. CONCLUSIONS This is first report of a nationwide survey pertaining to pediatric PPE/PE in Japan. We found that the etiology showed a different trend from that reported in other countries. It is worrisome that molecular methods were rarely used for pathogenic diagnosis and carbapenems were overused. Thus, it is imperative to establish clinical guidelines for PPE/PE in Japan.
Collapse
|
24
|
Tuğcu GD, Özsezen B, Türkyılmaz İ, Pehlivan Zorlu B, Eryılmaz Polat S, Özkaya Parlakay A, Cinel G. Risk factors for complicated community-acquired pneumonia in children. Pediatr Int 2022; 64:e15386. [PMID: 36225107 DOI: 10.1111/ped.15386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 08/05/2022] [Accepted: 10/12/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Community-acquired pneumonia (CAP) in children continues to be one of the prominent causes of pediatric morbidity and mortality worldwide. By determining the risk factors associated with the development of complicated CAP (CCAP), new approaches for early diagnosis and effective treatment can be identified. METHODS This retrospective cohort study enrolled patients with CAP and CCAP who visited the pediatric ward of the study hospital between January 1, 2017 and December 31, 2017. For patients with CCAP, data regarding medical procedures performed, surgical intervention, and hospitalization duration were collected. RESULTS A total of 111 patients, 93 (83.7%) with CAP and 18 (16.3%) with CCAP, aged between 3 months and 18 years were hospitalized because of severe pneumonia. The mean age of the patients was 3.6 ± 1.2 years and 60 (54%) of them were female. The mean age of patients with CCAP was higher than that of patients with CAP (4.2 ± 3.3 vs. 2.8 ± 2.1 years respectively); however, the difference was not significant (p = 0.012). Patients with CCAP exhibited a significantly higher C-reactive protein level than those with CAP (10.06 ± 7.55 vs. 4.43 ± 3.37 g/L respectively; p = 0.007). Hypoxia upon admission was noted more commonly in the CCAP group than in the CAP group (p < 0.001). CONCLUSION Findings related to hypoxia, respiratory distress, and pleural effusion on imaging are important distinguishing factors associated with the development of complications in patients hospitalized with CAP. Therefore, CCAP etiology, diagnosis, and treatment approaches should be established and protective measures adopted.
Collapse
Affiliation(s)
- Gökçen Dilşa Tuğcu
- Department of Pediatric Pulmonology, Children's Hospital, Ankara City Hospital, University of Health Science, Çankaya/Ankara, Turkey
| | - Beste Özsezen
- Department of Pediatric Pulmonology, Children's Hospital, Ankara City Hospital, University of Health Science, Çankaya/Ankara, Turkey
| | - İrem Türkyılmaz
- Department of Pediatrics, Children's Hospital, Ankara City Hospital, University of Health Science, Çankaya/Ankara, Turkey
| | - Betül Pehlivan Zorlu
- Department of Pediatrics, Children's Hospital, Ankara City Hospital, University of Health Science, Çankaya/Ankara, Turkey
| | - Sanem Eryılmaz Polat
- Department of Pediatric Pulmonology, Children's Hospital, Ankara City Hospital, University of Health Science, Çankaya/Ankara, Turkey
| | - Aslınur Özkaya Parlakay
- Department of Pediatric Infectious Diseases, Children's Hospital, Ankara City Hospital, University of Health Science, Çankaya/Ankara, Turkey
| | - Güzin Cinel
- Department of Pediatric Pulmonology, Children's Hospital, Ankara City Hospital, University of Health Science, Çankaya/Ankara, Turkey
| |
Collapse
|
25
|
Gautam A, Wiseman G, Legg R, Lindsay D, Puvvadi R, Rathnamma BM, Stalewski H, Norton R, White AV. Management of Pediatric Thoracic Empyema in the North Queensland Region of Australia and Impact of a Local Evidence-based Treatment Guideline. Pediatr Infect Dis J 2022; 41:1-5. [PMID: 34889868 DOI: 10.1097/inf.0000000000003341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM The North Queensland region of Australia has a high incidence of pediatric thoracic empyema (pTE). We describe the management of empyema at the Townsville University Hospital which is the regional referral center for these children. The impact of a newly developed institutional guideline is also discussed. METHODS This retrospective audit included children under the age of 16 years treated for empyema between 1 Jan 2007 and 31 December 2018. Demographic and management-related variables were correlated to outcomes. A local guideline was introduced at the beginning of 2017 and patient outcomes characteristics pre, and post introduction of this guideline are compared. RESULTS There were 153 children with pTE (123 before and 30 after the introduction of a local guideline). Nonsurgical management was associated with a higher treatment failure rate. Median length of stay (LOS) was 11.8 (IQR 9.3-16) days. Longer hospital LOS was associated with younger age (r2 -0.16, P = 0.04), Aboriginal and/or Torres Strait (ATSI) ancestry (13.8 vs. 10.5 days, P = 0.002) and concomitant respiratory viral infections (14.4 vs. 10.9 days, P = 0.003). The introduction of local guideline was associated with significant decrease in the use of empirical chest CT scans (54.4% before vs. 6.7% after, P < 0.001) and duration of intravenous antibiotics (14 days before vs. 10 days after, P = 0.02). There was no significant change in the hospital LOS (12.1 days pre and 11.7 post, P = 0.8). CONCLUSIONS Younger age, concomitant viral respiratory infections and ATSI ancestry were identified as potential risk factors for increase LOS. Hospital LOS following the adoption of an institutional guideline was unchanged. However, such a guideline may identify populations at risk for an unfavorable course and avoid unnecessary antibiotic treatment and radiation exposure.
Collapse
Affiliation(s)
- Anil Gautam
- From the Pediatric Intensive Care Unit, Townsville University Hospital, Douglas, Queensland, Australia
- James Cook University, Douglas, Queensland, Australia
| | - Gregory Wiseman
- From the Pediatric Intensive Care Unit, Townsville University Hospital, Douglas, Queensland, Australia
| | - Robert Legg
- Department of Pediatrics, Townsville University Hospital, Douglas, Queensland, Australia
- Great Ormond Street Institute of Child Health, University College London
| | - Daniel Lindsay
- Department of Public Health, James Cook University, Douglas, Queensland, Australia
| | - Ramaa Puvvadi
- Department of Pediatrics, Townsville University Hospital, Douglas, Queensland, Australia
| | | | - Harry Stalewski
- Pediatric Surgery, Townsville University Hospital, Douglas, Queensland, Australia
| | - Robert Norton
- Department of Microbiology, Townsville University Hospital, Douglas, Queensland, Australia
- University of Queensland, Brisbane, Australia
| | - Andrew Vernon White
- James Cook University, Douglas, Queensland, Australia
- Department of Pediatrics, Townsville University Hospital, Douglas, Queensland, Australia
| |
Collapse
|
26
|
González-Peris S, Campins M, García-García JJ, Díaz-Conradi Á, Domínguez Á, Ciruela P, de Sevilla MF, Hernández S, Muñoz-Almagro C, Izquierdo C, Codina G, Uriona S, Esteva C, Solé-Ribalta A, Soldevila N, Planes AM, Martínez-Osorio J, Salleras L, Moraga-Llop F. Necrotizing pneumonia due to Streptococcus pneumoniae in children during the period of non-systematic use of PCV13 in Catalonia, Spain. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2021; 39:486-492. [PMID: 34865709 DOI: 10.1016/j.eimce.2020.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/15/2020] [Indexed: 06/13/2023]
Abstract
BACKGROUND Some studies have observed an increased incidence of necrotizing pneumonia (NP) in recent years. This might be related to the emergence of non-vaccine S. pneumoniae serotypes after PCV7 introduction although it is suggested that evolutionary factors may have modified the virulence and the interactions of pneumococci. The aim of this study was to clinically and microbiologically define NP in the population served by the three major paediatric hospitals in Barcelona (Catalonia, Spain). METHODS A prospective observational study was conducted in patients <18 years hospitalized due to invasive pneumococcal disease (January 2012-June 2016). Data of confirmed cases of pneumococcal NP (diagnosed by culture or DNA detection and serotyped) were collected. PCV13 was not systematically administered in Catalonia during the study period, but was available in the private market so the vaccination coverage in children increased from 48.2% to 74.5%. RESULTS 35 cases of NP were identified. 77.1% of cases were associated with empyema. In the first 4 years, a trend to a decrease in NP incidence was observed (p=0.021), especially in children <5 years (p=0.006). Serotype 3 was responsible for 48.6% of NP cases. Five patients with NP due to serotype 3 were fully vaccinated for their age with PCV13. CONCLUSIONS Serotype 3 has a preeminent role in pneumococcal NP and was associated with all PCV13 vaccination failures. Although in our series the incidence does not seem to be increasing, evolution of pneumococcal NP rates should be monitored after inclusion of PCV13 in the systematic calendar.
Collapse
Affiliation(s)
| | - Magda Campins
- Hospital Universitari Vall d'Hebron, Barcelona, Spain; Grup de Recerca en Epidemiologia i Salut Pública, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Juan José García-García
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain; Malalties Prevenibles amb Vacunes, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | | | - Ángela Domínguez
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Departament de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Pilar Ciruela
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Agència de Salut Pública de Catalunya, Barcelona, Spain
| | - Mariona F de Sevilla
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain; Malalties Prevenibles amb Vacunes, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | | | - Carmen Muñoz-Almagro
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain; Departament de Medicina, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Conchita Izquierdo
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Agència de Salut Pública de Catalunya, Barcelona, Spain
| | - Gemma Codina
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Sonia Uriona
- Hospital Universitari Vall d'Hebron, Barcelona, Spain; Grup de Recerca en Epidemiologia i Salut Pública, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Cristina Esteva
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Anna Solé-Ribalta
- Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Núria Soldevila
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Departament de Medicina, Universitat de Barcelona, Barcelona, Spain
| | | | | | - Luis Salleras
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Departament de Medicina, Universitat de Barcelona, Barcelona, Spain
| | | |
Collapse
|
27
|
Rix-Trott K, Byrnes CA, Gilchrist CA, Matsas R, Walls T, Voss L, Mahon C, Dickson NP, Reed P, Best EJ. Surveillance of pediatric parapneumonic effusion/empyema in New Zealand. Pediatr Pulmonol 2021; 56:2949-2957. [PMID: 34232567 DOI: 10.1002/ppul.25564] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 06/07/2021] [Accepted: 07/01/2021] [Indexed: 11/07/2022]
Abstract
AIM The incidence of childhood empyema has been increasing in some developed countries despite the introduction of pneumococcal vaccination. This study aimed to document the incidence, bacterial pathogens, and morbidity/mortality of parapneumonic effusion/empyema in New Zealand. METHODS A prospective study of 102 children <15 years of age requiring hospitalization with parapneumonic effusion/empyema between May 1, 2014 and May 31, 2016 notified via the New Zealand Paediatric Surveillance Unit. Parapneumonic effusion/empyema was defined as pneumonia and pleural effusion persisting ≥7 days, and/or any pneumonia, and pleural effusion necessitating drainage. Notifying pediatricians completed standardized questionnaires. RESULTS Annual pediatric parapneumonic effusion/empyema incidence was 5.6/100,000 (95% confidence interval [CI]: 4.7-6.9). Most children (80%) required surgical intervention and 31% required intensive care. A causative organism was identified in 71/102 (70%) cases. Although Staphylococcus aureus (25%) and Streptococcus pneumoniae (25%) infection rates were equal, prolonged hospitalization and intensive care admission were more common in children with S. aureus PPE/E. Māori and Pasifika children were over-represented at 2.2 and 3.5 times, their representation in the New Zealand pediatric population. Pneumococcal vaccination was incomplete, with only 61% fully immunized and 30% unimmunized. Haemophilus influenzae type b vaccine uptake was near complete at 89/94 (95%), with influenza immunization only 3/78 (4%). CONCLUSIONS New Zealand has a high incidence of pediatric complicated parapneumonic effusion/empyema with significant morbidity. S. aureus was a significant cause of severe empyema in New Zealand, particularly for Māori and Pasifika children. Improvements in vaccine coverage are needed along with strategies to reduce S. aureus disease morbidity.
Collapse
Affiliation(s)
- Katherine Rix-Trott
- Starship Children's Health, Auckland District Health Board, Auckland, New Zealand.,KidzFirst Children's Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | - Catherine A Byrnes
- Starship Children's Health, Auckland District Health Board, Auckland, New Zealand.,Department of Paediatrics: Child and Youth Health, School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Catherine A Gilchrist
- Department of Paediatrics: Child and Youth Health, School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Richard Matsas
- KidzFirst Children's Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | - Tony Walls
- Department of Paediatrics, University of Otago, Christchurch, New Zealand.,Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Lesley Voss
- Starship Children's Health, Auckland District Health Board, Auckland, New Zealand
| | - Caroline Mahon
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Nigel P Dickson
- New Zealand Paediatric Surveillance Unit, Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Peter Reed
- Starship Children's Health, Auckland District Health Board, Auckland, New Zealand
| | - Emma J Best
- Starship Children's Health, Auckland District Health Board, Auckland, New Zealand.,Department of Paediatrics: Child and Youth Health, School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| |
Collapse
|
28
|
Haggie S, Selvadurai H, Gunasekera H, Fitzgerald DA. Paediatric pneumonia in high-income countries: Defining and recognising cases at increased risk of severe disease. Paediatr Respir Rev 2021; 39:71-81. [PMID: 33189568 DOI: 10.1016/j.prrv.2020.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 10/07/2020] [Indexed: 11/27/2022]
Abstract
World Health Organisation definitions of pneumonia severity are routinely used in research. In high income health care settings with high rates of pneumococcal vaccination and low rates of mortality, malnutrition and HIV infection, these definitions are less applicable. National guidelines from leading thoracic and infectious disease societies describe 'severe pneumonia' according to criteria derived from expert consensus rather than a robust evidence base. Contemporary cohort studies have used clinical outcomes such as intensive care therapy or invasive procedures for complicated pneumonia, to define severe disease. Describing severe pneumonia in such clinically relevant terms facilitates the identification of risk factors associated with worsened disease and the subsequently increased morbidity, and need for tertiary level care. The early recognition of children at higher risk of severe pneumonia informs site of care decisions, antibiotic treatment decisions as well as guiding appropriate investigations. Younger age, malnutrition, comorbidities, tachypnoea, and hypoxia have been identified as important associations with 'severe pneumonia' by WHO definition. Most studies have been performed in low-middle income countries and whilst they provide some insight into those at risk of mortality or treatment failure, their generalisability to the high-income setting is limited. There is a need to determine more precise definitions and criteria for severe disease in well-resourced settings and to validate factors associated with intensive care admission or invasive procedures to enhance the early recognition of those at risk.
Collapse
Affiliation(s)
- Stuart Haggie
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW 2145, Australia; Discipline of Child & Adolescent Health, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, NSW 2145, Australia; Department of Paediatrics, Shoalhaven District Memorial Hospital, Nowra 2541, Australia.
| | - Hiran Selvadurai
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW 2145, Australia; Discipline of Child & Adolescent Health, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, NSW 2145, Australia
| | - Hasantha Gunasekera
- Discipline of Child & Adolescent Health, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, NSW 2145, Australia
| | - Dominic A Fitzgerald
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW 2145, Australia; Discipline of Child & Adolescent Health, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, NSW 2145, Australia
| |
Collapse
|
29
|
Fernández L, Cima-Cabal MD, Duarte AC, Rodríguez A, García-Suárez MDM, García P. Gram-Positive Pneumonia: Possibilities Offered by Phage Therapy. Antibiotics (Basel) 2021; 10:antibiotics10081000. [PMID: 34439050 PMCID: PMC8388979 DOI: 10.3390/antibiotics10081000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/07/2021] [Accepted: 08/12/2021] [Indexed: 12/24/2022] Open
Abstract
Pneumonia is an acute pulmonary infection whose high hospitalization and mortality rates can, on occasion, bring healthcare systems to the brink of collapse. Both viral and bacterial pneumonia are uncovering many gaps in our understanding of host–pathogen interactions, and are testing the effectiveness of the currently available antimicrobial strategies. In the case of bacterial pneumonia, the main challenge is antibiotic resistance, which is only expected to increase during the current pandemic due to the widespread use of antibiotics to prevent secondary infections in COVID-19 patients. As a result, alternative therapeutics will be necessary to keep this disease under control. This review evaluates the advantages of phage therapy to treat lung bacterial infections, in particular those caused by the Gram-positive bacteria Streptococcus pneumoniae and Staphylococcus aureus, while also highlighting the regulatory impediments that hamper its clinical use and the difficulties associated with phage research.
Collapse
Affiliation(s)
- Lucía Fernández
- Instituto de Productos Lácteos de Asturias (IPLA-CSIC), Paseo Río Linares s/n, 33300 Villaviciosa, Asturias, Spain; (L.F.); (A.C.D.); (A.R.)
- DairySafe Group, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Asturias, Spain
| | - María Dolores Cima-Cabal
- Escuela Superior de Ingeniería y Tecnología (ESIT), Universidad Internacional de la Rioja (UNIR), Av. de la Paz, 137, 26006 Logroño, La Rioja, Spain;
| | - Ana Catarina Duarte
- Instituto de Productos Lácteos de Asturias (IPLA-CSIC), Paseo Río Linares s/n, 33300 Villaviciosa, Asturias, Spain; (L.F.); (A.C.D.); (A.R.)
- DairySafe Group, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Asturias, Spain
| | - Ana Rodríguez
- Instituto de Productos Lácteos de Asturias (IPLA-CSIC), Paseo Río Linares s/n, 33300 Villaviciosa, Asturias, Spain; (L.F.); (A.C.D.); (A.R.)
- DairySafe Group, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Asturias, Spain
| | - María del Mar García-Suárez
- Escuela Superior de Ingeniería y Tecnología (ESIT), Universidad Internacional de la Rioja (UNIR), Av. de la Paz, 137, 26006 Logroño, La Rioja, Spain;
- Correspondence: (M.d.M.G.-S.); (P.G.)
| | - Pilar García
- Instituto de Productos Lácteos de Asturias (IPLA-CSIC), Paseo Río Linares s/n, 33300 Villaviciosa, Asturias, Spain; (L.F.); (A.C.D.); (A.R.)
- DairySafe Group, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Asturias, Spain
- Correspondence: (M.d.M.G.-S.); (P.G.)
| |
Collapse
|
30
|
Forster J, Piazza G, Goettler D, Kemmling D, Schoen C, Rose M, Streng A, Liese JG. Effect of Prehospital Antibiotic Therapy on Clinical Outcome and Pathogen Detection in Children With Parapneumonic Pleural Effusion/Pleural Empyema. Pediatr Infect Dis J 2021; 40:544-549. [PMID: 33395211 DOI: 10.1097/inf.0000000000003036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Parapneumonic pleural effusion and pleural empyema (PPE/PE) are complications of community-acquired pneumonia. The objective of this study was to analyze prehospital antibiotic therapy (PH-ABT) of children with PPE/PE and investigate its effects on clinical outcome and pathogen detection. METHODS Prospective nationwide active surveillance in Germany between October 2010 and June 2018. Children and adolescents <18 years of age with pneumonia-associated PE or PPE requiring drainage or with persistence of PPE/PE >7 days were included. RESULTS A total of 1724 children with PPE/PE were reported, of whom 556 children (32.3% of 1719 with available data) received PH-ABT. Children with PH-ABT had a shorter median hospital length of stay (15 vs. 18 days, P < 0.001), a longer time from onset of symptoms until hospital discharge (25 vs. 23 days, P = 0.002), a lower rate of intensive care unit admission (58.3% vs. 64.4%, P = 0.015) and fewer infectious complications (5.9% vs. 10.0%; P = 0.005). Bacterial pathogens in blood or pleural fluid culture were detected in 597 (34.5%) of 1513 children. Positive culture results were less frequent in children with than without PH-ABT (81/466 [17.4%] vs. 299/1005 [29.8%]; P < 0.001), whereas detection rates in pleural fluid samples by polymerase chain reaction were similar (91/181 [50.3%] vs. 220/398 [55.3%]; P = 0.263). CONCLUSIONS In children with PPE/PE, PH-ABT significantly reduced the overall rate of bacterial pathogen detection by culture, but not by polymerase chain reaction. PH-ABT was associated with a lower rate of infectious complications but did not affect the overall duration of disease. We therefore speculate that the duration of PPE/PE is mainly a consequence of an infection-induced inflammatory process, which can only partially be influenced by antibiotic treatment.
Collapse
Affiliation(s)
- Johannes Forster
- From the University of Wuerzburg, Institute of Hygiene and Microbiology, Wuerzburg, Germany
| | - Giuseppina Piazza
- From the University of Wuerzburg, Institute of Hygiene and Microbiology, Wuerzburg, Germany
- Department of Pediatrics, University Hospital of Wuerzburg, Wuerzburg, Germany
- Klinikum Stuttgart, Olgahospital- Pediatric Pulmonology, Stuttgart, Germany
| | - David Goettler
- Department of Pediatrics, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Daniel Kemmling
- Department of Pediatrics, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Christoph Schoen
- From the University of Wuerzburg, Institute of Hygiene and Microbiology, Wuerzburg, Germany
| | - Markus Rose
- Klinikum Stuttgart, Olgahospital- Pediatric Pulmonology, Stuttgart, Germany
| | - Andrea Streng
- Department of Pediatrics, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Johannes G Liese
- Department of Pediatrics, University Hospital of Wuerzburg, Wuerzburg, Germany
| |
Collapse
|
31
|
Esposito S, Dal Canto G, Caramia MR, Fainardi V, Pisi G, Principi N. Complications in community acquired pneumonia: magnitude of problem, risk factors, and management in pediatric age. Expert Rev Anti Infect Ther 2021; 20:45-51. [PMID: 33971782 DOI: 10.1080/14787210.2021.1927710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: In the last decades, the large use of several effective vaccines has dramatically reduced the incidence of community acquired pneumonia (CAP) in infants and children. Moreover, the availability of new antibiotics effective against emerging resistant strains of bacteria has greatly improved the early and long-term prognosis of this disease.Areas covered: The aim of this manuscript is to evaluate the burden of complicated CAP in pediatric age and to discuss its appropriate management.Expert opinion: Complicated CAP remains a problem for children in industrialized and developing countries. A larger use of lung ultrasonography (US) as first diagnostic approach could significantly improve early identification of cases at higher risk of complications. Difficult to solve, is the problem of the use of an antibiotic therapy able to assure adequate control in all the CAP cases, including those at high risk of or with already established complications. All these findings reveal that control of the incidence of complicated CAP remains difficult and will not be significantly changed in the next few years. Any attempt to improve complicated CAP management must be made. Consensus documents on better definition of the use of corticosteroids, fibrinolytic agents, and interventional procedures (including surgery) can allow us to reach this goal.
Collapse
Affiliation(s)
- Susanna Esposito
- Pediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
| | - Giulia Dal Canto
- Pediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
| | - Maria Rosaria Caramia
- Pediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
| | - Valentina Fainardi
- Pediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
| | - Giovanna Pisi
- Pediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
| | | |
Collapse
|
32
|
Sorg AL, Obermeier V, Liese JG, von Kries R. Incidence trends of parapneumonic pleural effusions/empyema in children 2009 to 2018 from health insurance data: Only temporal reduction after the introduction of PCV13. Vaccine 2021; 39:3516-3519. [PMID: 34006409 DOI: 10.1016/j.vaccine.2021.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 04/30/2021] [Accepted: 05/03/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Recently, emergence of a higher proportion of serotype 3 in children with parapneumonic pleural effusion/empyema (PPE/PE) were observed in Germany despite general immunization with 13-valent pneumococcal conjugate vaccine (PCV13) since 2009. The impact of PCV13 on the overall incidence of PPE/PE in children is unclear. METHODS Annual incidence of PPE/PE in children were determined using secondary health care data for 2009-2018, provided by the Barmer statutory health insurer, serving about 11% of the German population. Temporal trends of the annual incidence were modelled applying generalized additive models. RESULTS Overall incidence of PPE/PE in children ( ≤18 years) in the ten-year observation period was 18.17 per 100,000. The 0-1 year olds showed the highest incidence (43.09 per 100 000). PPE/PE incidence decreased from 2009 until 2013 (nadir 2013 was 15.36; 95% CI: 13.41-17.31). Since 2013, the data show an annual increase. The nadir of incidence for the 2-5 year olds (15.85; 95% CI: 11.27-20.43) and the 6-18 year olds (12.29; 95% CI: 10.23-14.36) was also in 2013, whereas for the 0-1 year olds it was found in 2014 (32.66; 95% CI: 23.79-41.54). The GAM across all age groups showed a nearly U-shaped curve between time and incidence of PPE/PE by calendar year (p-non-linear = 0.0017). The model confirms the nadir in the year 2013. DISCUSSION We found a nonlinear temporal trend of PPE/PE incidence in children with a decrease from 2009 to 2013 and a subsequent increase until 2018. The former might be explained by a quasi elimination of serotype 1, the latter by an increase in the proportion of serotype 3 as demonstrated in German surveillance data of pediatric PPE/PE cases generated during the same observation period.
Collapse
Affiliation(s)
- Anna-Lisa Sorg
- Division of Pediatric Epidemiology, Institute of Social Pediatrics and Adolescent Medicine, Ludwig-Maximilians-University Munich, Munich, Germany.
| | - Viola Obermeier
- Division of Pediatric Epidemiology, Institute of Social Pediatrics and Adolescent Medicine, Ludwig-Maximilians-University Munich, Munich, Germany.
| | - Johannes G Liese
- University Hospital of Wuerzburg, Department of Pediatrics, Division of Pediatric Infectious Diseases, Wuerzburg, Germany.
| | - Rüdiger von Kries
- Division of Pediatric Epidemiology, Institute of Social Pediatrics and Adolescent Medicine, Ludwig-Maximilians-University Munich, Munich, Germany.
| |
Collapse
|
33
|
Carloni I, Ricci S, Rubino C, Cobellis G, Rinaldelli G, Azzari C, de Benedictis FM. Necrotizing pneumonia among Italian children in the pneumococcal conjugate vaccine era. Pediatr Pulmonol 2021; 56:1127-1135. [PMID: 33442941 DOI: 10.1002/ppul.25270] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/23/2020] [Accepted: 12/25/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Necrotizing pneumonia (NP) is a severe complication of community-acquired pneumonia. The impact of 13-valent pneumococcal conjugate vaccine (PCV13) on the epidemiology of NP in children has not been assessed. PATIENTS AND METHODS Medical records of children less than 18 years admitted with NP to two pediatric hospitals in Italy between 2005 and 2019 were reviewed. The following four periods were defined: 2005-2010 (pre-PCV13), 2011-2013 (early post-PCV13), 2014-2016 (intermediate post-PCV13), and 2017-2019 (late post-PCV13). RESULTS Forty-three children (median age, 44 months) were included. Most of them (93%) were previously healthy. No differences in age, sex, season of admission, comorbidity, clinical presentation, or hospital course were identified between pre-PCV13 and post-PCV13 periods. A significant decrease in the rate of NP-associated hospitalizations was found between the early (1.5/1000 admissions/year) and the intermediate (0.35/1000 admissions/year) post-PCV13 period (p = .001). An increased trend in admissions was found thereafter. Streptococcus pneumoniae was the most common agent detected in both periods (pre-PCV13: 11/18, 61%; post-PCV13: 13/25, 52%). Serotype 3 was the most common strain in both periods (pre-PCV13: 3/11, 27%; post-PCV13; 4/13, 31%). There were no changes in the etiology over time, but most patients with Streptococcus pyogenes or Staphylococcus aureus infection were admitted during the post-PCV13 period. CONCLUSIONS The hospitalization rate for NP in children decreased a few years after the implementation of PCV13 immunization in Italy. However, an increased trend in admissions was found thereafter. S. pneumoniae was the most frequent causal agent in both pre- and post-PCV13 periods. Pneumococcal serotypes were mainly represented by Strain 3.
Collapse
Affiliation(s)
- Ines Carloni
- Pediatric Infectious Disease Unit, Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy
| | - Silvia Ricci
- Department of Health Sciences, Meyer Children's University Hospital, Florence, Italy
| | - Chiara Rubino
- Department of Health Sciences, Meyer Children's University Hospital, Florence, Italy
| | - Giovanni Cobellis
- Pediatric Surgery Unit, Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy
| | - Giampaolo Rinaldelli
- Pediatric Intensive Care Unit, Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy
| | - Chiara Azzari
- Department of Health Sciences, Meyer Children's University Hospital, Florence, Italy
| | | |
Collapse
|
34
|
Thoracic Empyema Secondary to Congenital Chylothorax in a 14-Month-Old Boy with Noonan Syndrome. Case Rep Pediatr 2021; 2021:6620353. [PMID: 34012687 PMCID: PMC8105093 DOI: 10.1155/2021/6620353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 04/23/2021] [Indexed: 12/10/2022] Open
Abstract
Thoracic empyema usually occurs as a complication of bacterial pneumonia, but in rare cases, it is caused by hematogenous dissemination secondary to nonpulmonary diseases. Congenital chylothorax or chylothorax in children is associated with maldevelopment of the lymphatic system, nonimmune hydrops fetalis, several syndromes including Down syndrome, Noonan syndrome, or Turner syndrome, a complication of thoracic surgery, right heart failure with high central venous pressure, or tumors. There are very few reports of empyema associated with preexisting chylothorax. In the present study, we describe a rare case of thoracic empyema associated with congenital chylothorax and supravalvular pulmonary stenosis associated with clinically diagnosed Noonan syndrome. It is necessary to closely monitor patients with chylothorax because they are at risk of developing severe lung infections, such as pleural empyema or lung abscesses.
Collapse
|
35
|
The impact of pneumococcal conjugate vaccine-13 on the incidence of pediatric community-acquired bacteremia. Eur J Clin Microbiol Infect Dis 2021; 40:1433-1439. [PMID: 33537906 DOI: 10.1007/s10096-021-04167-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 01/14/2021] [Indexed: 10/22/2022]
Abstract
The purpose of this study was to estimate the impact of pneumococcal conjugate vaccine-13 (PCV-13) introduction into the national immunization program in Israel on pneumococcal and non-pneumococcal pediatric community-acquired bacteremia (CAB). This is a retrospective cohort study, including children ≤ 18 years old with CAB, who were hospitalized in Rambam Health Care Campus, a tertiary medical center serving northern Israel, between the years 2004 and 2016. The proportional admission rate of pneumococcal bacteremia among all CAB events and the incidence of CAB and pneumococcal bacteremia per 1000 hospital admissions were compared between the pre- and post-pneumococcal vaccine eras. A total of 275 CAB events were identified. Common isolates were Streptococcus pneumoniae (SPn) (26.9%), Staphylococcus aureus (12.4%), Brucella spp. (11.6%), E. coli (10.9%), and Streptococcus pyogenes (5.8%). The pneumococcal bacteremia rate per 1000 hospital admissions decreased significantly from 1.59 to 0.6 (p < 0.001). The proportional pneumococcal bacteremia rate decreased from 55 (34.4%) to 19 (16.5%) (p 0.001). Penicillin resistance among pneumococcal isolates decreased dramatically from 50.9 to 5.3% (p < 0.001). The rate of bacteremia caused by other pathogens has not been changed significantly at the post-vaccination era (p 0.053). However, an increase in the incidence of S. pyogenes bacteremia from 1.9 to 11.3% (p < 0.001) was noticed. In addition, an outbreak of Brucella bacteremia occurred during the years 2015-2016. This study demonstrates the double positive effect of PVC-13 introduction: a sharp decrease in the proportional rate of pneumococcal bacteremia and in the resistance of SPn to penicillin. Also, there was a moderate decline in the incidence of CAB in exception to bacteremia caused by S. pyogenes. This trend was reversed due to a Brucella outbreak.
Collapse
|
36
|
Evolución de la distribución de serotipos de Streptococcus pneumoniae aislados en líquido pleural en la Comunidad de Madrid entre los años 2007 y 2018. Enferm Infecc Microbiol Clin 2021; 39:25-28. [DOI: 10.1016/j.eimc.2020.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 02/03/2020] [Accepted: 02/08/2020] [Indexed: 11/18/2022]
|
37
|
González-Peris S, Campins M, García-García JJ, Díaz-Conradi Á, Domínguez Á, Ciruela P, de Sevilla MF, Hernández S, Muñoz-Almagro C, Izquierdo C, Codina G, Uriona S, Esteva C, Solé-Ribalta A, Soldevila N, Planes AM, Martínez-Osorio J, Salleras L, Moraga-Llop F. Necrotizing pneumonia due to Streptococcus pneumoniae in children during the period of non-systematic use of PCV13 in Catalonia, Spain. Enferm Infecc Microbiol Clin 2020; 39:S0213-005X(20)30291-3. [PMID: 33131931 DOI: 10.1016/j.eimc.2020.08.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/11/2020] [Accepted: 08/15/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Some studies have observed an increased incidence of necrotizing pneumonia (NP) in recent years. This might be related to the emergence of non-vaccine S. pneumoniae serotypes after PCV7 introduction although it is suggested that evolutionary factors may have modified the virulence and the interactions of pneumococci. The aim of this study was to clinically and microbiologically define NP in the population served by the three major paediatric hospitals in Barcelona (Catalonia, Spain). METHODS A prospective observational study was conducted in patients <18 years hospitalized due to invasive pneumococcal disease (January 2012-June 2016). Data of confirmed cases of pneumococcal NP (diagnosed by culture or DNA detection and serotyped) were collected. PCV13 was not systematically administered in Catalonia during the study period, but was available in the private market so the vaccination coverage in children increased from 48.2% to 74.5%. RESULTS 35 cases of NP were identified. 77.1% of cases were associated with empyema. In the first 4 years, a trend to a decrease in NP incidence was observed (p=0.021), especially in children <5 years (p=0.006). Serotype 3 was responsible for 48.6% of NP cases. Five patients with NP due to serotype 3 were fully vaccinated for their age with PCV13. CONCLUSIONS Serotype 3 has a preeminent role in pneumococcal NP and was associated with all PCV13 vaccination failures. Although in our series the incidence does not seem to be increasing, evolution of pneumococcal NP rates should be monitored after inclusion of PCV13 in the systematic calendar.
Collapse
Affiliation(s)
| | - Magda Campins
- Hospital Universitari Vall d'Hebron, Barcelona, Spain; Grup de Recerca en Epidemiologia i Salut Pública, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Juan José García-García
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain; Malalties Prevenibles amb Vacunes, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | | | - Ángela Domínguez
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Departament de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Pilar Ciruela
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Agència de Salut Pública de Catalunya, Barcelona, Spain
| | - Mariona F de Sevilla
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain; Malalties Prevenibles amb Vacunes, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | | | - Carmen Muñoz-Almagro
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain; Departament de Medicina, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Conchita Izquierdo
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Agència de Salut Pública de Catalunya, Barcelona, Spain
| | - Gemma Codina
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Sonia Uriona
- Hospital Universitari Vall d'Hebron, Barcelona, Spain; Grup de Recerca en Epidemiologia i Salut Pública, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Cristina Esteva
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Anna Solé-Ribalta
- Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Núria Soldevila
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Departament de Medicina, Universitat de Barcelona, Barcelona, Spain
| | | | | | - Luis Salleras
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Departament de Medicina, Universitat de Barcelona, Barcelona, Spain
| | | |
Collapse
|
38
|
Thoracoscopic debridement for empyema thoracis. J Pediatr Surg 2020; 55:2187-2190. [PMID: 32147236 DOI: 10.1016/j.jpedsurg.2020.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 12/27/2019] [Accepted: 02/05/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND/PURPOSE The success rate of early thoracoscopic debridement (TD) for childhood empyema was reviewed in light of the increasing reported incidence of empyema associated with pulmonary necrosis (PN). METHODS Data were collected from 106 patients who underwent thoracoscopic intervention from 2010 to 2016. Twenty additional patients with severe PN/Bronchopleural Fistula (BPF) were not suitable for TD requiring thoracotomy and Serratus anterior digitation flap. RESULTS 106 patients with a median age of 4 years (IQR 2-6 years) were considered for TD as primary intervention of which 3 needed conversion to thoracotomy. TD alone was successful in 93/106 however, 10 patients required subsequent minithoracotomy for PN/BPF (managed with Serratus anterior digitation flap). Counting conversions as failure, the overall success rate of TD was 88%. No statistical difference was demonstrable in success rate compared to our previous series (93% (106/114) vs 88% (93/106)). CONCLUSIONS Primary TD in pediatric empyema is associated with an excellent outcome achieving adequate drainage and full expansion of the lung. The majority of failures in our series were attributable to PN/BPF, requiring thoracotomy and Serratus anterior digitation flap. This is likely a consequence of the increasing incidence of necrotizing pneumonia. LEVEL OF EVIDENCE Level IV.
Collapse
|
39
|
de Benedictis FM, Kerem E, Chang AB, Colin AA, Zar HJ, Bush A. Complicated pneumonia in children. Lancet 2020; 396:786-798. [PMID: 32919518 DOI: 10.1016/s0140-6736(20)31550-6] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/20/2020] [Accepted: 06/10/2020] [Indexed: 12/13/2022]
Abstract
Complicated community-acquired pneumonia in a previously well child is a severe illness characterised by combinations of local complications (eg, parapneumonic effusion, empyema, necrotising pneumonia, and lung abscess) and systemic complications (eg, bacteraemia, metastatic infection, multiorgan failure, acute respiratory distress syndrome, disseminated intravascular coagulation, and, rarely, death). Complicated community-acquired pneumonia should be suspected in any child with pneumonia not responding to appropriate antibiotic treatment within 48-72 h. Common causative organisms are Streptococcus pneumoniae and Staphylococcus aureus. Patients have initial imaging with chest radiography and ultrasound, which can also be used to assess the lung parenchyma, to identify pleural fluid; CT scanning is not usually indicated. Complicated pneumonia is treated with a prolonged course of intravenous antibiotics, and then oral antibiotics. The initial choice of antibiotic is guided by local microbiological knowledge and by subsequent positive cultures and molecular testing, including on pleural fluid if a drainage procedure is done. Information from pleural space imaging and drainage should guide the decision on whether to administer intrapleural fibrinolytics. Most patients are treated by drainage and more extensive surgery is rarely needed; in any event, in low-income and middle-income countries, resources for extensive surgeries are scarce. The clinical course of complicated community-acquired pneumonia can be prolonged, especially when patients have necrotising pneumonia, but complete recovery is the usual outcome.
Collapse
Affiliation(s)
| | - Eitan Kerem
- Department of Pediatrics, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Anne B Chang
- Child Health Division, Menzies School of Health Research, Darwin, NT, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, QLD, Australia; Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Andrew A Colin
- Division of Pediatric Pulmonology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross Children's Hospital, Cape Town, South Africa; MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Andrew Bush
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial School of Medicine, Imperial College London, London, UK.
| |
Collapse
|
40
|
Characteristics of Streptococcus pyogenes Versus Streptococcus pneumoniae Pleural Empyema and Pneumonia With Pleural Effusion in Children. Pediatr Infect Dis J 2020; 39:799-802. [PMID: 32804461 DOI: 10.1097/inf.0000000000002699] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Streptococcus pneumoniae is the most common cause of complicated pneumonia in children, but its incidence is decreasing since the introduction of the antipneumococcal conjugated vaccines. Streptococcus pyogenes is an uncommon cause of community-acquired pleuropneumonia/empyema in children, but its relative incidence is rising. METHODS The medical records of all children 0-18 years of age from 2004 to 2019, with discharge diagnoses of pleuropneumonia or empyema, and a positive blood and/or pleural effusion culture for group A streptococcus (GAS) (S. pyogenes), or S. pneumonia (SP) were reviewed. A comparison of clinical and laboratory characteristics for the 2 etiologies was performed. RESULTS Ninety cases of community-acquired pleuropneumonia/empyema caused by these organisms were included: 20 GAS and 70 SP. Compared with children with SP, those with GAS were more likely to have larger pleural effusion requiring drainage and longer hospitalization, and less likely to have a positive blood culture. The relative portion of GAS empyema increased over the study period. CONCLUSIONS Compared with patients with SP empyema, GAS appears to cause more morbidity and a longer hospital stay. This organism is more frequently recovered from pleural fluid without bacteremia, and thus necessitates pleural fluid tap for accurate diagnosis.
Collapse
|
41
|
Haggie S, Gunasekera H, Pandit C, Selvadurai H, Robinson P, Fitzgerald DA. Paediatric empyema: worsening disease severity and challenges identifying patients at increased risk of repeat intervention. Arch Dis Child 2020; 105:886-890. [PMID: 32209557 DOI: 10.1136/archdischild-2019-318219] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 02/06/2020] [Accepted: 03/08/2020] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Empyema is the most common complication of pneumonia. Primary interventions include chest drainage and fibrinolytic therapy (CDF) or video-assisted thoracoscopic surgery (VATS). We describe disease trends, clinical outcomes and factors associated with reintervention. DESIGN/SETTING/PATIENTS Retrospective cohort of paediatric empyema cases requiring drainage or surgical intervention, 2011-2018, admitted to a large Australian tertiary children's hospital. RESULTS During the study, the incidence of empyema increased from 1.7/1000 to 7.1/1000 admissions (p<0.001). We describe 192 cases (174 CDF and 18 VATS), median age 3.0 years (IQR 1-5), mean fever duration prior to intervention 6.2 days (SD ±3.3 days) and 50 (26%) cases admitted to PICU. PICU admission increased during the study from 18% to 34% (p<0.001). Bacteraemia occurred in 23/192 (12%) cases. A pathogen was detected in 131/192 (68%); Streptococcus pneumoniae 75/192 (39%), S. aureus 25/192 (13%) and group A streptococcus 13/192 (7%). Reintervention occurred in 49/174 (28%) and 1/18 (6%) following primary CDF and VATS. Comparing repeat intervention with single intervention cases, a continued fever postintervention increased the likelihood for a repeat intervention (OR 1.3 per day febrile; 95% CI 1.2 to 1.4, p<0.0001). Younger age, prolonged fever preintervention and previous antibiotic treatment were not associated with initial treatment failure (all p>0.05). CONCLUSION We report increasing incidence and severity of empyema in a large tertiary hospital. One in four patients required a repeat intervention after CDF. Neither clinical variables at presentation nor early investigations were able to predict initial treatment failure.
Collapse
Affiliation(s)
- Stuart Haggie
- Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Hasantha Gunasekera
- Department of Discipline of Paediatrics and Child Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Chetan Pandit
- Department of Respiratory Medicine, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Hiran Selvadurai
- Department of Respiratory Medicine, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Paul Robinson
- Department of Respiratory Medicine, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Dominic A Fitzgerald
- Department of Respiratory Medicine, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| |
Collapse
|
42
|
Sim JY, Chang LY, Chang TH, Chen JM, Lee PI, Huang LM, Lu CY. Pediatric parapneumonic effusion before and after national pneumococcal vaccination programs in Taiwan. J Formos Med Assoc 2020; 119:1608-1618. [PMID: 32747171 DOI: 10.1016/j.jfma.2020.07.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/06/2020] [Accepted: 07/16/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Reports on the effectiveness of pneumococcal conjugate vaccines (PCVs) on pediatric parapneumonic effusion are limited. We report the changes in cases and etiologies of pediatric parapneumonic effusion in a children's hospital before and after national PCV13 vaccination programs. METHODS We screened medical records of children 0-18 years admitted to the National Taiwan University Hospital with diagnoses of lobar pneumonia and parapneumonic effusion between 2008 and 2017. Patients with effusion analyses were included. Results of blood, pleural fluid, and respiratory specimens surveyed as standard care were analyzed. RESULTS Diagnostic testing revealed at least a pathogen in 85% of 202 children with lobar pneumonia and parapneumonic effusion. After national PCV13 immunization, pneumococcal empyema decreased by 72% among 2- to 5-year olds. Mycoplasma pneumoniae was the second most common etiology. There were marked differences in effusion characteristics, metabolic, and respiratory parameters between children infected with pneumococcus and M. pneumoniae. CONCLUSION The effectiveness of the national PCV13 immunization programs on pneumococcal empyema was evident and remained substantial after 4 years in Taiwan. Continuous surveillance is important to monitor the emergence of other pathogens including non-PCV serotypes and M. pneumoniae.
Collapse
Affiliation(s)
- Jun Yi Sim
- Department of Pediatrics, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 289 Jianguo Road, Xindian District, New Taipei City, 23142, Taiwan
| | - Luan-Yin Chang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, 8 Chung-Shan South Road, Taipei City, 10002, Taiwan
| | - Tu-Hsuan Chang
- Department of Pediatrics, Chi-Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 71004, Taiwan
| | - Jong-Min Chen
- Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, 8 Chung-Shan South Road, Taipei City, 10002, Taiwan
| | - Ping-Ing Lee
- Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, 8 Chung-Shan South Road, Taipei City, 10002, Taiwan
| | - Li-Min Huang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, 8 Chung-Shan South Road, Taipei City, 10002, Taiwan
| | - Chun-Yi Lu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, 8 Chung-Shan South Road, Taipei City, 10002, Taiwan.
| |
Collapse
|
43
|
Gregory P, Rahman NM, Lee YCG. Osler Centenary Papers: Management of pleural infection: Osler's final illness and recent advances. Postgrad Med J 2020; 95:656-659. [PMID: 31754057 DOI: 10.1136/postgradmedj-2018-135893] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 06/24/2019] [Accepted: 08/06/2019] [Indexed: 12/16/2022]
Abstract
Sir William Osler's great work and achievements are extensively documented. Less well known is his prolonged battle with postinfluenza pneumonia, lung abscess and pleural infection that eventually led to his demise. At the age of 70, he was a victim of the global Spanish influenza epidemic, and subsequently developed pneumonia. In the era before antibiotics, he received supportive care and opium for symptom control. The infection extended to the pleura and he required repeated thoracentesis which failed to halt his deterioration. He proceeded to open surgical drainage involving rib resection. Unfortunately, he died shortly after the operation from massive pleuropulmonary haemorrhage. In this article, we review the events leading up to Osler's death and contrast his care 100 years ago with contemporary state-of-the-art management in pleural infection.
Collapse
Affiliation(s)
- Prudence Gregory
- Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Najib M Rahman
- Oxford Centre for Respiratory Medicine, University of Oxford, Oxford, UK
| | - Y C Gary Lee
- Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia .,School of Medicine & Centre for Respiratory Health, University of Western Australia, Perth, Western Australia, Australia
| |
Collapse
|
44
|
Rajkumar P, Bharathy S, Girish Kumar CP, Veeraraghavan B, Verghese V, Gupta N, Kangusamy B, Ravi M, Jayaraman Y. Hospital-based sentinel surveillance for Streptococcus pneumoniae and other invasive bacterial diseases in India (HBSSPIBD): design and methodology. BMJ Open 2020; 10:e034663. [PMID: 32273315 PMCID: PMC7245370 DOI: 10.1136/bmjopen-2019-034663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Streptococcus pneumoniae is one of the frequently isolated organisms and an important aetiological agent of invasive bacterial diseases (IBD) like pneumonia, meningitis and sepsis. As a measure to control the burden of IBD, the Government of India introduced Pneumoccocal Conjugate Vaccine-13 (PCV-13) in the Universal Immunization Program in high burden districts of five states in a phased manner from 2017 onwards. It is essential to understand the trend of circulating pneumococcal serotypes associated with IBD in the prevaccination and postvaccination scenarios to decide on the expansion of vaccination programmes and PCV reformulation. This manuscript describes the protocol for hospital-based sentinel surveillance for S. pneumoniae and other organisms causing IBD across various geographical regions in India. METHODS AND ANALYSIS Hospital-based surveillance is established in selected hospitals to recruit children aged 1-59 months with symptoms of pneumonia and other IBD. Diagnostic criteria were adapted from standard WHO case definitions. Case Report Forms (CRFs) are used to collect data from the enrolled children. Blood, cerebrospinal fluid (CSF) and other normally sterile body fluids are collected and subjected to microscopy, cytology, latex agglutination, biochemistry, bacteriological culture and real-time PCR as applicable. Pneumococcal isolates are serotyped and tested for assessing antimicrobial resistance patterns. Data will be analysed by simple descriptive statistics to estimate the proportion of pneumonia and other IBD due to S. pneumoniae, Hemophilus influenzae type b and Neisseria meningitidis. Prevalence of bacterial infection, circulating pneumococcal serotypes, antibiotic resistance patterns, serotype variability across seasons and regions will be described in terms of percentage with 95% confidence interval. ETHICS AND DISSEMINATION The institutional review boards of the coordinating centre, all sentinel sites, regional and national reference laboratories approved the project. The results will be published in peer-reviewed journals and shared with stakeholders for deciding on revising vaccination strategy appropriately.
Collapse
Affiliation(s)
- Prabu Rajkumar
- Health Systems Research, ICMR-National Institute of Epidemiology, Chennai, India
| | - Sukumar Bharathy
- Health Systems Research, ICMR-National Institute of Epidemiology, Chennai, India
| | - C P Girish Kumar
- Laboratory Division, ICMR-National Institute of Epidemiology, Chennai, India
| | - Balaji Veeraraghavan
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Valsan Verghese
- Department of Child Health, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Nivedita Gupta
- Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Boopathi Kangusamy
- Health Systems Research, ICMR-National Institute of Epidemiology, Chennai, India
| | - Muthusamy Ravi
- Computing and Information Science, ICMR-National Institute of Epidemiology, Chennai, India
| | - Yuvaraj Jayaraman
- Health Systems Research, ICMR-National Institute of Epidemiology, Chennai, India
| |
Collapse
|
45
|
Livingston MH, Mahant S, Connolly B, MacLusky I, Laberge S, Giglia L, Yang C, Roberts A, Shawyer A, Brindle M, Parsons S, Stoian C, Walton JM, Thorpe KE, Chen Y, Zuo F, Mamdani M, Chan C, Loong D, Isaranuwatchai W, Ratjen F, Cohen E. Effectiveness of Intrapleural Tissue Plasminogen Activator and Dornase Alfa vs Tissue Plasminogen Activator Alone in Children with Pleural Empyema: A Randomized Clinical Trial. JAMA Pediatr 2020; 174:332-340. [PMID: 32011642 PMCID: PMC7042898 DOI: 10.1001/jamapediatrics.2019.5863] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Clinical guidelines recommend that children with pleural empyema be treated with chest tube insertion and intrapleural fibrinolytics. The addition of dornase alfa (DNase) has been reported to improve outcomes in adults but remains unproven in children. OBJECTIVE To determine if intrapleural tissue plasminogen activator (tPA) and DNase is more effective than tPA and placebo at reducing hospital length of stay in children with pleural empyema. DESIGN, SETTING, AND PARTICIPANTS This multicenter, parallel-group, placebo-controlled, superiority randomized clinical trial included children diagnosed as having pleural empyema requiring drainage aged 6 months to 18 years treated at 6 tertiary Canadian children's hospitals. A total of 379 children were assessed for eligibility; 281 were excluded and 98 were randomized. One child was excluded after randomization for not meeting the inclusion criteria. Data were collected from March 4, 2013, to December 13, 2017. INTERVENTIONS Participants underwent chest tube insertion and 3 daily administrations of intrapleural tPA, 4 mg, followed by DNase, 5 mg (intervention group), or 5 mL of normal saline (placebo; control group). Participants, families, clinical staff, and members of the study team were blinded to allocation. MAIN OUTCOMES AND MEASURES The primary outcome was hospital length of stay from chest tube insertion to discharge. Secondary outcomes included time to meeting discharge criteria, time to chest tube removal, mean fever duration, additional pleural drainage procedures, hospital readmissions, and total health care cost. RESULTS Of the 97 analyzed children with pleural empyema, 52 (54%) were male, and the mean (SD) age was 5.1 (3.6) years. A total of 49 children were randomized to tPA and DNase and 48 were randomized to tPA and placebo. Treatment with tPA and DNase was not associated with decreased hospital length of stay compared with tPA and placebo (mean [SD] length of stay, 9.0 [4.9] vs 9.1 [5.3] days; mean difference, -0.1 days; 95% CI, -2.0 to 2.1; P = .96). Similarly, no significant differences were observed for any of the secondary outcomes. Of the 14 adverse events in the tPA and DNase group, 6 (43%) were serious; of the 21 adverse events in the tPA and placebo group, 8 (38%) were serious. There were no deaths. CONCLUSIONS AND RELEVANCE The addition of DNase to intrapleural tPA for children with pleural empyema had no effect on hospital length of stay or other outcomes compared with tPA with placebo. Clinical practice guidelines should continue to support the use of chest tube insertion and intrapleural fibrinolytics alone as first-line treatment for pediatric empyema. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01717742.
Collapse
Affiliation(s)
- Michael H. Livingston
- McMaster Children’s Hospital, McMaster University, Hamilton, Ontario, Canada,Golisano Children’s Hospital, University of Rochester Medical Center, Rochester, New York
| | - Sanjay Mahant
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Bairbre Connolly
- Image-Guided Therapy, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Ian MacLusky
- Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Sophie Laberge
- Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Lucia Giglia
- McMaster Children’s Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Connie Yang
- British Columbia’s Children’s Hospital, Division of Respiratory Medicine, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ashley Roberts
- British Columbia’s Children’s Hospital, Division of Respiratory Medicine, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anna Shawyer
- Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - Mary Brindle
- Alberta Children’s Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Simon Parsons
- Alberta Children’s Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Cristina Stoian
- Alberta Children’s Hospital, University of Calgary, Calgary, Alberta, Canada
| | - J. Mark Walton
- McMaster Children’s Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Kevin E. Thorpe
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Yang Chen
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Fei Zuo
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Muhammad Mamdani
- Li Ka Shing Centre for Healthcare Analytics Research and Training, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Carol Chan
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Desmond Loong
- Centre for Excellence in Economic Analysis Research (CLEAR), The HUB Health Research Solutions, St Michael’s Hospital, Toronto, Ontario, Canada,Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Wanrudee Isaranuwatchai
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,Centre for Excellence in Economic Analysis Research (CLEAR), The HUB Health Research Solutions, St Michael’s Hospital, Toronto, Ontario, Canada,Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Felix Ratjen
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Eyal Cohen
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
46
|
Del Rosal T, Caminoa MB, González-Guerrero A, Falces-Romero I, Romero-Gómez MP, Baquero-Artigao F, Sainz T, Méndez-Echevarría A, Escosa-García L, Aracil FJ, Calvo C. Outcome of Severe Bacterial Pneumonia in the Era of Pneumococcal Vaccination. Front Pediatr 2020; 8:576519. [PMID: 33384973 PMCID: PMC7769833 DOI: 10.3389/fped.2020.576519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 11/27/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: After the introduction of pneumococcal conjugate vaccines, community-acquired pneumonia (CAP) caused by Streptococcus pneumoniae has decreased whereas Staphylococcus aureus and Streptococcus pyogenes could be increasing. These bacteria have been associated with high rates of complications. Aims: (1) To describe the characteristics of pediatric bacterial CAP requiring hospitalization. (2) To compare outcomes according to causative microorganisms. (3) To analyze changes in bacterial CAP rate and etiology over time. Patients and Methods: Retrospective single-center study of inpatients aged 1 month-16 years with culture-confirmed bacterial CAP in 2010-2018 in Madrid, Spain. Results: We included 64 cases (42 S. pneumoniae, 13 S. pyogenes and 9 S. aureus). Culture-confirmed CAP represented 1.48-2.33/1,000 all-cause pediatric hospital admissions, and its rate did not vary over time. However, there was a significant decrease in pneumococcal CAP in the last 3 years of the study (78% of CAP in 2010-2015 vs. 48% in 2016-18, p = 0.017). Median hospital stay was 10.5 days (interquartile range 5-19.5), 38 patients (59%) developed complications and 28 (44%) were admitted to the intensive care unit. Outcomes were similar among children with S. pneumoniae and S. aureus CAP, whereas S. pyogenes was associated with a higher risk for complications (OR 8 [95%CI 1.1-57.2]) and ICU admission (OR 7.1 [95%CI 1.7-29.1]) compared with pneumococcal CAP. Conclusion: In a setting with high PCV coverage, culture-confirmed bacterial CAP did not decrease over time and there was a relative increase of S. pyogenes and S. aureus. Children with CAP caused by S. pyogenes were more likely to develop complications.
Collapse
Affiliation(s)
- Teresa Del Rosal
- Department of Pediatric Infectious Diseases, Hospital Universitario La Paz and IdiPAZ Research Institute, Madrid, Spain
| | | | - Alba González-Guerrero
- Department of Pediatric Infectious Diseases, Hospital Universitario La Paz and IdiPAZ Research Institute, Madrid, Spain
| | - Iker Falces-Romero
- Department of Microbiology, Hospital Universitario La Paz, Madrid, Spain
| | | | - Fernando Baquero-Artigao
- Department of Pediatric Infectious Diseases, Hospital Universitario La Paz and IdiPAZ Research Institute, Madrid, Spain
| | - Talía Sainz
- Department of Pediatric Infectious Diseases, Hospital Universitario La Paz and IdiPAZ Research Institute, Madrid, Spain.,Red de Investigación Traslacional en Infectología Pediátrica, Madrid, Spain
| | - Ana Méndez-Echevarría
- Department of Pediatric Infectious Diseases, Hospital Universitario La Paz and IdiPAZ Research Institute, Madrid, Spain
| | - Luis Escosa-García
- Department of Pediatric Infectious Diseases, Hospital Universitario La Paz and IdiPAZ Research Institute, Madrid, Spain
| | - Francisco Javier Aracil
- Department of Pediatric Infectious Diseases, Hospital Universitario La Paz and IdiPAZ Research Institute, Madrid, Spain
| | - Cristina Calvo
- Department of Pediatric Infectious Diseases, Hospital Universitario La Paz and IdiPAZ Research Institute, Madrid, Spain.,Red de Investigación Traslacional en Infectología Pediátrica, Madrid, Spain
| |
Collapse
|
47
|
Levy C, Ouldali N, Caeymaex L, Angoulvant F, Varon E, Cohen R. Diversity of Serotype Replacement After Pneumococcal Conjugate Vaccine Implementation in Europe. J Pediatr 2019; 213:252-253.e3. [PMID: 31561776 DOI: 10.1016/j.jpeds.2019.07.057] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 07/23/2019] [Indexed: 01/27/2023]
Affiliation(s)
- Corinne Levy
- Université Paris Est, Mondor Institute of Biomedical Research-Groupement de Recherche Clinique (IMRB-GRC) Groupe d'étude de Maladies Infectieuses Néonatales et Infantiles (GEMINI), Créteil, France; Association Clinique Thérapeutique Infantile du Val de Marne (ACTIV), Pediatric Clinical and Therapeutical Association of the Val de Marne, Saint-Maur des Fossés, France; Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, Créteil, France; Association Française de Pédiatrie Ambulatoire (GPIP), Pediatric Infectious Disease Group, France; AFPA, French Association of Ambulatory Pediatricians, Saint-Germain-en-Laye, France.
| | - Naim Ouldali
- Association Clinique Thérapeutique Infantile du Val de Marne (ACTIV), Pediatric Clinical and Therapeutical Association of the Val de Marne, Saint-Maur des Fossés, France; Association Française de Pédiatrie Ambulatoire (GPIP), Pediatric Infectious Disease Group, France; Unité d'épidémiologie clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, ECEVE INSERM UMR 1123, Paris, France
| | - Laurence Caeymaex
- Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, Créteil, France; Neonatal Intensive Care Unit, Centre Hospitalier Intercommunal de Créteil, University Paris Est Créteil, Créteil, France
| | - François Angoulvant
- Association Française de Pédiatrie Ambulatoire (GPIP), Pediatric Infectious Disease Group, France; Department of General Pediatrics and Pediatric Infectious Diseases, Necker Hospital for Sick Children, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France
| | - Emmanuelle Varon
- Association Française de Pédiatrie Ambulatoire (GPIP), Pediatric Infectious Disease Group, France; National Reference Centre for Pneumococci, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Robert Cohen
- Université Paris Est, Mondor Institute of Biomedical Research-Groupement de Recherche Clinique (IMRB-GRC) Groupe d'étude de Maladies Infectieuses Néonatales et Infantiles (GEMINI), Créteil, France; Association Clinique Thérapeutique Infantile du Val de Marne (ACTIV), Pediatric Clinical and Therapeutical Association of the Val de Marne, Saint-Maur des Fossés, France; Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, Créteil, France; Association Française de Pédiatrie Ambulatoire (GPIP), Pediatric Infectious Disease Group, France; AFPA, French Association of Ambulatory Pediatricians, Saint-Germain-en-Laye, France; Unité Court Séjour, Petits Nourrissons, Service de Néonatologie, Centre Hospitalier Intercommunal de Créteil, France
| |
Collapse
|
48
|
Pleural Tap-Guided Antimicrobial Treatment for Pneumonia with Parapneumonic Effusion or Pleural Empyema in Children: A Single-Center Cohort Study. J Clin Med 2019; 8:jcm8050698. [PMID: 31100958 PMCID: PMC6572435 DOI: 10.3390/jcm8050698] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 05/01/2019] [Accepted: 05/08/2019] [Indexed: 01/01/2023] Open
Abstract
Parapneumonic effusion or pleural empyema (PPE/PE) is a frequent complication of community-acquired pneumonia (CAP) in children. Different management approaches exist for this condition. We evaluated a 14-day treatment with amoxicillin (AMX) with/without clavulanic acid (AMC) confirmed or modified by microbiological findings from pleural tap. Children ≤16 years of age with radiologically diagnosed PPE/PE and initial diagnostic pleural tap were included at University Children’s Hospital Zurich from 2001–2015. AMX/AMC was given for 14 days and rationalized according to microbiological pleural tap results. Clinical and radiological follow-up was scheduled until six months or full recovery. In 114 of 147 (78%) children with PPE/PE a pathogen was identified by culture, polymerase chain reaction (PCR), and/or antigen testing. Streptococcus pneumoniae was detected in 90 (79%), S. pyogenes in 13 (11%), and Staphylococcus aureus in seven cases (6%), all but two cultured pathogens (96%) were sensitive to AMX/AMC. One-hundred two of 147 (69%) patients received treatment with AMX/AMC for 14 days. They recovered more rapidly than patients with a different management (p = 0.026). Of 139 children with follow-up, 134 (96%) patients fully recovered. In conclusion, 14-day AMX/AMC treatment confirmed and rarely modified by microbiological findings from pleural tap resulted in full recovery in >95% of children with PPE/PE.
Collapse
|