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Van Dyke MK, Pirçon JY, Cohen R, Madhi SA, Rosenblüt A, Macias Parra M, Al-Mazrou K, Grevers G, Lopez P, Naranjo L, Pumarola F, Sonsuwan N, Hausdorff WP. Etiology of Acute Otitis Media in Children Less Than 5 Years of Age: A Pooled Analysis of 10 Similarly Designed Observational Studies. Pediatr Infect Dis J 2017; 36:274-281. [PMID: 27918383 PMCID: PMC5312727 DOI: 10.1097/inf.0000000000001420] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/27/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Acute otitis media (AOM) is an important cause of childhood morbidity and antibiotic prescriptions. However, the relative importance of the well-known otopathogens, Streptococcus pneumoniae (Spn) and Haemophilus influenzae (Hflu), remains unclear because of a limited number of tympanocentesis-based studies that vary significantly in populations sampled, case definitions and heptavalent pneumococcal conjugate vaccine use. METHODS We conducted a pooled analysis of results from 10 AOM etiology studies of similar design, the protocols of which were derived from a common protocol and conducted in children 3 months to 5 years of age in different countries. Generalized estimating equations were used to account for within-study correlations. RESULTS The majority, 55.5% (95% confidence interval: 47.0%-65.7%) of 1124 AOM episodes, were bacterial pathogen positive: 29.1% (24.8%-34.1%) yielded Hflu and 23.6% (19.0%-29.2%) Spn. Proportions of Hflu and Spn were higher and lower, respectively, in heptavalent pneumococcal conjugate vaccine-vaccinated children. Hflu and Spn were each isolated from 20% to 35% of children in every 1-year age range. Hflu was less likely to be isolated from first (vs. subsequent) episodes [relative risk (RR): 0.71 (0.60-0.84)]. Spn was more often isolated from sporadic (vs. recurrent) cases [RR: 0.76 (0.61-0.97)]; the opposite was true for Hflu [RR: 1.4 (1.00-1.96)]. Spn cases were more likely to present with severe (vs. mild) symptoms [RR: 1.42 (1.01-2.01)] and Hflu cases with severe tympanic membrane inflammation [RR: 1.35 (1.06-1.71)]. CONCLUSIONS Spn and Hflu remain the leading otopathogens in all populations examined. While associated with overlapping symptoms and severity, they exhibit some differences in their likelihood to cause disease in specific subpopulations.
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Affiliation(s)
- Melissa K. Van Dyke
- From the GSK Vaccines, Wavre, Belgium; Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Saint-Maur-des-Fossés, CHI Créteil and UPEC, France; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Unidad de Otorrinolaringologia, Hospital Dr Sotero del Rio, Puente Alto, Santiago, Chile; Departamento de Infectologia, Instituto Nacional de Pediatría de la Secretaría de Salud (SSA), Mexico City, Mexico; Otolaryngology Department, King Saud University & King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; ENT-Center, Prinzenweg 1, 82319 Starnberg, Germany; Centros de Estudios Infectologia Pediatrica, Cali, Colombia; GSK Biologicals, Ciudad Panama, Panama; Sección de ORL Pediátrica, Hospital Universitari Vall d’Hebron, Barcelona, Spain; and Otolaryngology Department, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand
| | - Jean-Yves Pirçon
- From the GSK Vaccines, Wavre, Belgium; Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Saint-Maur-des-Fossés, CHI Créteil and UPEC, France; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Unidad de Otorrinolaringologia, Hospital Dr Sotero del Rio, Puente Alto, Santiago, Chile; Departamento de Infectologia, Instituto Nacional de Pediatría de la Secretaría de Salud (SSA), Mexico City, Mexico; Otolaryngology Department, King Saud University & King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; ENT-Center, Prinzenweg 1, 82319 Starnberg, Germany; Centros de Estudios Infectologia Pediatrica, Cali, Colombia; GSK Biologicals, Ciudad Panama, Panama; Sección de ORL Pediátrica, Hospital Universitari Vall d’Hebron, Barcelona, Spain; and Otolaryngology Department, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand
| | - Robert Cohen
- From the GSK Vaccines, Wavre, Belgium; Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Saint-Maur-des-Fossés, CHI Créteil and UPEC, France; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Unidad de Otorrinolaringologia, Hospital Dr Sotero del Rio, Puente Alto, Santiago, Chile; Departamento de Infectologia, Instituto Nacional de Pediatría de la Secretaría de Salud (SSA), Mexico City, Mexico; Otolaryngology Department, King Saud University & King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; ENT-Center, Prinzenweg 1, 82319 Starnberg, Germany; Centros de Estudios Infectologia Pediatrica, Cali, Colombia; GSK Biologicals, Ciudad Panama, Panama; Sección de ORL Pediátrica, Hospital Universitari Vall d’Hebron, Barcelona, Spain; and Otolaryngology Department, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand
| | - Shabir A. Madhi
- From the GSK Vaccines, Wavre, Belgium; Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Saint-Maur-des-Fossés, CHI Créteil and UPEC, France; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Unidad de Otorrinolaringologia, Hospital Dr Sotero del Rio, Puente Alto, Santiago, Chile; Departamento de Infectologia, Instituto Nacional de Pediatría de la Secretaría de Salud (SSA), Mexico City, Mexico; Otolaryngology Department, King Saud University & King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; ENT-Center, Prinzenweg 1, 82319 Starnberg, Germany; Centros de Estudios Infectologia Pediatrica, Cali, Colombia; GSK Biologicals, Ciudad Panama, Panama; Sección de ORL Pediátrica, Hospital Universitari Vall d’Hebron, Barcelona, Spain; and Otolaryngology Department, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand
| | - Andrés Rosenblüt
- From the GSK Vaccines, Wavre, Belgium; Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Saint-Maur-des-Fossés, CHI Créteil and UPEC, France; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Unidad de Otorrinolaringologia, Hospital Dr Sotero del Rio, Puente Alto, Santiago, Chile; Departamento de Infectologia, Instituto Nacional de Pediatría de la Secretaría de Salud (SSA), Mexico City, Mexico; Otolaryngology Department, King Saud University & King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; ENT-Center, Prinzenweg 1, 82319 Starnberg, Germany; Centros de Estudios Infectologia Pediatrica, Cali, Colombia; GSK Biologicals, Ciudad Panama, Panama; Sección de ORL Pediátrica, Hospital Universitari Vall d’Hebron, Barcelona, Spain; and Otolaryngology Department, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand
| | - Mercedes Macias Parra
- From the GSK Vaccines, Wavre, Belgium; Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Saint-Maur-des-Fossés, CHI Créteil and UPEC, France; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Unidad de Otorrinolaringologia, Hospital Dr Sotero del Rio, Puente Alto, Santiago, Chile; Departamento de Infectologia, Instituto Nacional de Pediatría de la Secretaría de Salud (SSA), Mexico City, Mexico; Otolaryngology Department, King Saud University & King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; ENT-Center, Prinzenweg 1, 82319 Starnberg, Germany; Centros de Estudios Infectologia Pediatrica, Cali, Colombia; GSK Biologicals, Ciudad Panama, Panama; Sección de ORL Pediátrica, Hospital Universitari Vall d’Hebron, Barcelona, Spain; and Otolaryngology Department, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand
| | - Khalid Al-Mazrou
- From the GSK Vaccines, Wavre, Belgium; Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Saint-Maur-des-Fossés, CHI Créteil and UPEC, France; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Unidad de Otorrinolaringologia, Hospital Dr Sotero del Rio, Puente Alto, Santiago, Chile; Departamento de Infectologia, Instituto Nacional de Pediatría de la Secretaría de Salud (SSA), Mexico City, Mexico; Otolaryngology Department, King Saud University & King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; ENT-Center, Prinzenweg 1, 82319 Starnberg, Germany; Centros de Estudios Infectologia Pediatrica, Cali, Colombia; GSK Biologicals, Ciudad Panama, Panama; Sección de ORL Pediátrica, Hospital Universitari Vall d’Hebron, Barcelona, Spain; and Otolaryngology Department, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand
| | - Gerhard Grevers
- From the GSK Vaccines, Wavre, Belgium; Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Saint-Maur-des-Fossés, CHI Créteil and UPEC, France; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Unidad de Otorrinolaringologia, Hospital Dr Sotero del Rio, Puente Alto, Santiago, Chile; Departamento de Infectologia, Instituto Nacional de Pediatría de la Secretaría de Salud (SSA), Mexico City, Mexico; Otolaryngology Department, King Saud University & King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; ENT-Center, Prinzenweg 1, 82319 Starnberg, Germany; Centros de Estudios Infectologia Pediatrica, Cali, Colombia; GSK Biologicals, Ciudad Panama, Panama; Sección de ORL Pediátrica, Hospital Universitari Vall d’Hebron, Barcelona, Spain; and Otolaryngology Department, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand
| | - Pio Lopez
- From the GSK Vaccines, Wavre, Belgium; Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Saint-Maur-des-Fossés, CHI Créteil and UPEC, France; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Unidad de Otorrinolaringologia, Hospital Dr Sotero del Rio, Puente Alto, Santiago, Chile; Departamento de Infectologia, Instituto Nacional de Pediatría de la Secretaría de Salud (SSA), Mexico City, Mexico; Otolaryngology Department, King Saud University & King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; ENT-Center, Prinzenweg 1, 82319 Starnberg, Germany; Centros de Estudios Infectologia Pediatrica, Cali, Colombia; GSK Biologicals, Ciudad Panama, Panama; Sección de ORL Pediátrica, Hospital Universitari Vall d’Hebron, Barcelona, Spain; and Otolaryngology Department, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand
| | - Laura Naranjo
- From the GSK Vaccines, Wavre, Belgium; Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Saint-Maur-des-Fossés, CHI Créteil and UPEC, France; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Unidad de Otorrinolaringologia, Hospital Dr Sotero del Rio, Puente Alto, Santiago, Chile; Departamento de Infectologia, Instituto Nacional de Pediatría de la Secretaría de Salud (SSA), Mexico City, Mexico; Otolaryngology Department, King Saud University & King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; ENT-Center, Prinzenweg 1, 82319 Starnberg, Germany; Centros de Estudios Infectologia Pediatrica, Cali, Colombia; GSK Biologicals, Ciudad Panama, Panama; Sección de ORL Pediátrica, Hospital Universitari Vall d’Hebron, Barcelona, Spain; and Otolaryngology Department, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand
| | - Felix Pumarola
- From the GSK Vaccines, Wavre, Belgium; Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Saint-Maur-des-Fossés, CHI Créteil and UPEC, France; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Unidad de Otorrinolaringologia, Hospital Dr Sotero del Rio, Puente Alto, Santiago, Chile; Departamento de Infectologia, Instituto Nacional de Pediatría de la Secretaría de Salud (SSA), Mexico City, Mexico; Otolaryngology Department, King Saud University & King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; ENT-Center, Prinzenweg 1, 82319 Starnberg, Germany; Centros de Estudios Infectologia Pediatrica, Cali, Colombia; GSK Biologicals, Ciudad Panama, Panama; Sección de ORL Pediátrica, Hospital Universitari Vall d’Hebron, Barcelona, Spain; and Otolaryngology Department, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand
| | - Nuntigar Sonsuwan
- From the GSK Vaccines, Wavre, Belgium; Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Saint-Maur-des-Fossés, CHI Créteil and UPEC, France; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Unidad de Otorrinolaringologia, Hospital Dr Sotero del Rio, Puente Alto, Santiago, Chile; Departamento de Infectologia, Instituto Nacional de Pediatría de la Secretaría de Salud (SSA), Mexico City, Mexico; Otolaryngology Department, King Saud University & King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; ENT-Center, Prinzenweg 1, 82319 Starnberg, Germany; Centros de Estudios Infectologia Pediatrica, Cali, Colombia; GSK Biologicals, Ciudad Panama, Panama; Sección de ORL Pediátrica, Hospital Universitari Vall d’Hebron, Barcelona, Spain; and Otolaryngology Department, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand
| | - William P. Hausdorff
- From the GSK Vaccines, Wavre, Belgium; Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Saint-Maur-des-Fossés, CHI Créteil and UPEC, France; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Unidad de Otorrinolaringologia, Hospital Dr Sotero del Rio, Puente Alto, Santiago, Chile; Departamento de Infectologia, Instituto Nacional de Pediatría de la Secretaría de Salud (SSA), Mexico City, Mexico; Otolaryngology Department, King Saud University & King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; ENT-Center, Prinzenweg 1, 82319 Starnberg, Germany; Centros de Estudios Infectologia Pediatrica, Cali, Colombia; GSK Biologicals, Ciudad Panama, Panama; Sección de ORL Pediátrica, Hospital Universitari Vall d’Hebron, Barcelona, Spain; and Otolaryngology Department, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand
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Chiu NC, Chi H, Peng CC, Chang HY, Huang DTN, Chang L, Lei WT, Lin CY. Retrospective study of prognostic factors in pediatric invasive pneumococcal disease. PeerJ 2017; 5:e2941. [PMID: 28149700 PMCID: PMC5270593 DOI: 10.7717/peerj.2941] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 12/26/2016] [Indexed: 12/27/2022] Open
Abstract
Streptococcus pneumoniae remains the leading causative pathogen in pediatric pneumonia and bacteremia throughout the world. The invasive pneumococcal disease (IPD) is known as isolation of S. pneumoniae from a normally sterile site (e.g., blood, cerebrospinal fluid, synovial fluid, pericardial fluid, pleural fluid, or peritoneal fluid). The aim of this study is to survey the clinical manifestations and laboratory results of IPD and identify the prognostic factors of mortality. From January 2001 to December 2006, a retrospective review of chart was performed in a teaching hospital in Taipei. The hospitalized pediatric patients with the diagnosis of pneumonia, arthritis, infectious endocarditis, meningitis or sepsis were recruited. Among them, 50 patients were pneumococcal infections proved by positive culture results or antigen tests. Clinical manifestations, laboratory data and hospitalization courses were analyzed. The median age was 3.5-year-old and there were 30 male patients (60%). Eight patients (16%) had underlying disease such as leukemia or congenital heart disease. Hemolytic uremic syndrome (HUS) was observed in ten patients and extracorporeal membrane oxygenation (ECMO) was performed in three patients. Leukocytosis, elevated C-reactive protein and AST level were noted in most of the patients. The overall mortality rate was 10%. We found that leukopenia, thrombocytopenia and high CRP level were significant predictors for mortality. In conclusion, S. pneumoniae remains an important health threat worldwide and IPD is life-threatening with high mortality rate. We found leukopenia, thrombocytopenia, and high CRP levels to be associated with mortality in pediatric IPD, and these factors are worthy of special attention at admission. Although we failed to identify a statistically significant prognostic factor in multivariate analysis due to relatively small sample size, we suggest an aggressive antibiotic treatment in patients with these factors at admission. Further large-scale studies are warranted.
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Affiliation(s)
- Nan-Chang Chiu
- Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan.,MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan.,MacKay Medical College, New Taipei, Taiwan
| | - Hsin Chi
- Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan.,MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan.,MacKay Medical College, New Taipei, Taiwan
| | - Chun-Chih Peng
- Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan.,MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan.,MacKay Medical College, New Taipei, Taiwan
| | - Hung-Yang Chang
- Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan.,Department of Medical Technology, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
| | - Daniel Tsung-Ning Huang
- Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan.,MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Lung Chang
- Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan.,MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Wei-Te Lei
- Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
| | - Chien-Yu Lin
- Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
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