Pneumococcal bacteremia in children: an 8-year review in two hospitals in Barcelona

Pneumococcemia in children--a retrospective study before universal pneumococcal vaccinations

AIM

To evaluate the incidence and characteristics of blood culture-positive occult pneumococcemia compared with blood culture-positive pneumococcal pneumonia in children.

METHODS

In years 2001-2010, 105 children with positive blood cultures for Streptococcus pneumoniae were identified from hospital electronic files. The patient cards were retrospectively charted for clinical and laboratory data, and 38 patients had and 67 had not pneumonia.

RESULTS

The annual incidence of pneumococcemia was, on average, 29.0/10 000 at 0-12 months, 5.3/10 000 at 13-24 months and 1.9/10 000 at 2-4 years of ages, with no increasing or decreasing trend. The incidence of bacteraemic pneumococcal pneumonia increased (p = 0.022) during the study period. The duration of fever before hospitalization (<24 h 73.9% vs. 25.0%, p = 0.022) and the duration of intravenous antibiotics, usually G-penicillin (median 72 vs. 96 h, p = 0.021) was shorter in pneumococcemia patients. On admission, blood leucocyte count was higher in pneumococcemia (mean 26.6 vs. 21.9 × 10E9/L, p = 0.012), but serum CRP was higher in pneumonia (median 160 vs. 67.4 mg/L, p < 0.001). The serotypes 6B and 14 caused 53.2% of pneumococcemia cases.

CONCLUSION

The incidence of pneumococcemia was highest in 1-2-year-old children, and typical for pneumococcemia was rapid onset of fever, high blood leucocyte count and a modestly elevated CRP on admission.

Pediatric parapneumonic pleural effusion: epidemiology, clinical characteristics, and microbiological diagnosis

BACKGROUND

In recent years an increase in the incidence and severity of parapneumonic pleural effusion (PPE) in pediatric populations has been observed. Streptococcus pneumoniae remains the main causal agent. New molecular and antigen techniques have increased the microbiological diagnosis of this pathology.

OBJECTIVES

To describe the epidemiology and clinical characteristics of PPE in our population.

PATIENTS AND METHODS

Prospective study of patients under the age of 18 years admitted for PPE in a tertiary-care pediatric hospital in Barcelona (Spain) between September 2003 and December 2006.

RESULTS

One hundred ninety cases of PPE were diagnosed. The annual incidence of PPE in the population under 18 years of age increased from 19.9 cases per 100,000 in 2004 to 35.2 per 100,000 in 2006. S. pneumoniae was the main causal agent identified: 82.9% of the 21.6% patients with positive culture. Non-vaccine serotypes (NVS) predominated (81.5%), and serotype 1 was responsible for 38.5% of cases. The use of polymerase chain reaction (PCR) test to detect S. pneumoniae increased etiological diagnosis from 21.6% to 42.1%. Antigen assays used to detect pneumococcus in pleural fluid demonstrated 87.9% sensitivity and 100% specificity when PCR was used as the gold standard.

CONCLUSIONS

There has been an increase in the incidence of PPE that parallels the increase in CAP. S. pneumoniae remains the principal causal agent, and NVS clearly predominate. The use of PCR to detect S. pneumoniae substantially increases etiologic diagnosis. The use of antigen assays to detect pneumococcus in pleural fluid is a quick and sensitive diagnostic method, and thus a valid alternative to PCR.

Burden of paediatric invasive pneumococcal disease in Europe, 2005

Within the European Union (EU), documenting the burden of invasive pneumococcal disease (IPD) in infants and children is important for coordinating effective pneumococcal immunization policies. Our objective was to document the burden of IPD in countries of the EU plus Switzerland and Norway. European affiliates of Wyeth Vaccines made available recent epidemiological data on IPD from local disease surveillance programmes, including unpublished sources. Recent literature and websites were also searched to provide as wide a representation as possible. This included OVID and abstracts from a number of international meetings, dating from the year 2000. The reported rates of paediatric IPD per 100000 (age) ranged from a low of 1.7 (<2 years) to 4.2 (2-15 years) in Sweden to a high of 93.5 to 174 (<2 years) to 56.2 (<5 years) in Spain. The percentage of circulating serotypes causing IPD that are covered by 7-valent pneumococcal conjugate vaccine (PCV) IPD serotype coverage ranged from 60% to 80% for European children aged <2 years. Under reporting, differences in reporting methods, antibiotic prescribing and disparities in blood-culturing practices may explain the differences in reported disease incidence. Because of the excellent clinical efficacy of the PCV against IPD, national pneumococcal vaccination programmes in Europe have the potential to prevent much morbidity and mortality.

Impact of the pneumococcal conjugate vaccine in the management of highly febrile children aged 6 to 24 months in an emergency department

OBJECTIVE

To evaluate the impact of the introduction of the heptavalent pneumococcal conjugate vaccine (PCV-7) in the management of children aged 6 to 24 months with high fever without source (FWS) in a pediatric emergency department (PED).

METHODS

Retrospective study of 770 patients aged 6 to 24 months attended in a pediatric ED between October 2004 and April 2005 with FWS 39 degrees C or higher without alteration in the dipstick.

RESULTS

Out of 770 children, 215 (27.9%) were PCV-7 fully vaccinated (group A), and 555 (72.0%) were either incompletely PCV-7 vaccinated or not vaccinated at all (group B). Both groups did not show differences related to temperature registered at home or in the ED. Complete blood count (CBC) and blood culture were practiced in 163 (21.1%) patients, chest radiograph in 117 (15.1%), and lumbar puncture in 15 (1.9%). Thirty-three patients (4.3%) received a dose of intramuscular ceftriaxone, 20 (2.6%) were admitted to the observation unit, and 5 (0.6) were admitted to the hospital. One blood culture was positive, and 2 other children had a consolidation in the chest radiograph (all in group B). In patients not fully vaccinated with PCV-7, CBC and blood culture were practiced more frequently (group B, 26.6% vs. group A, 7%; P < 0.000001; odds ratio, 4.85 [limits, 2.70-8.83]) and ceftriaxone was also more frequently administered (group B, 5.3% vs. group A, 1.3%; P = 0.02; odds ratio, 4.04 [limits, 1.16-16.77]). Three children in group A (1.4%) were admitted to the observation unit or to floor versus 22 in group B (4%, P = 0.11).

CONCLUSIONS

Inclusion of PCV-7 vaccinal status in the management of highly febrile children aged 6 to 24 months significantly reduces CBC and blood cultures practiced in the ED and the administration of ceftriaxone.

Controlling invasive pneumococcal disease: is vaccination of at-risk groups sufficient?

Risk factors for invasive pneumococcal disease (IPD) include young and old age, comorbidities (such as splenic dysfunction, immunodeficiencies, chronic renal disease, chronic heart or lung disease or cerebral spinal fluid leak), crowded environments or poor socioeconomic conditions. Universal use of the 7-valent pneumococcal conjugate (7vPncCRM) vaccine for infants and young children has led to significant decreases in IPD in the vaccinated population (direct protection), and there has also been a decrease in the incidence of IPD among the nonvaccinated population (indirect immunity; herd protection). While 7vPncCRM vaccine is administered universally to children in USA, many countries of the European Union have chosen to target children with comorbidities. This review aims to highlight individual risk factors for IPD, describe studies that evaluated pneumococcal conjugate vaccines in at-risk groups and estimate the proportion of at-risk children who may have been vaccinated in the European Union since the 7vPncCRM vaccine was introduced, using UK as an example. Although immunisation targeting only children with comorbidities may achieve satisfactory results for a few, many otherwise healthy children at risk simply because of their age will be neglected, and herd protection might not be established.

Derrame pleural paraneumónico: revisión de 11 años

INTRODUCTION

In the last few years, the incidence of parapneumonic effusions in children with community-acquired pneumonia seems to have increased. The aim of this study was to determine the clinical features and incidence of parapneumonic effusions throughout an 11-year period.

MATERIAL AND METHODS

We retrospectively reviewed the medical records of patients aged < 15 years old with parapneumonic effusions from 1993 to 2003. Annual incidence rates were calculated per 100,000 children < 15 years old from Health Area 5 of Madrid and per 100 children hospitalized in the Infectious Diseases Department of our hospital. The linear association test was used to compare the incidence rates over the previous 11 years.

RESULTS

There were 130 patients with parapneumonic pleural effusions. The mean age was 4.7 years. Forty-one percent received antibiotics before diagnosis. The causative organisms were identified in 42 patients (32.3%). The most effective diagnostic method was pleural-fluid culture (18/58, 31%). The most common organisms were Streptococcus pneumoniae (18), Mycoplasma pneumoniae (8), Staphylococcus aureus (4), Streptococcus pyogenes (3), Haemophilus influenzae (3) and Mycobacterium tuberculosis (2). Thirty-two percent of the patients required pleural drainage and 16% underwent video-assisted thoracoscopic surgery. Of 12 S. pneumoniae antibiograms available, 91.7% showed full susceptibility to penicillin and 75% were susceptible to erythromycin. The annual incidence of parapneumonic effusions rose from 18.1 in 1993 to 42.9 in 2003 (p < 0.001) per 100,000 children and from 0.76 in 1993 to 3.3 in 2003 (p < 0.001) per 100 children hospitalized in our unit.

CONCLUSION

The incidence of parapneumonic effusions in children with community-acquired pneumonia showed a statistically significant increase between 1993 and 2003. The most common causal organism was S. pneumoniae, with a low rate of penicillin resistance.