Hayley Hernstadt1,2, Abigail Cheung3, Daniel Hurem4, Nan Vasilunas5, Linny Kimly Phuong6,7, Patrick Quinn3, Rishi Agrawal4, Andrew J Daley8, Theresa Cole9, Amanda Gwee2,7,10. 1. From the Department of Paediatric Infectious Diseases, St Mary's Hospital, Imperial College Healthcare Trust, London, United Kingdom. 2. Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia. 3. Department of Immunology, Women's and Children's Hospital, Adelaide, South Australia, Australia. 4. Department of General Medicine, Paediatrics, Women's and Children's Hospital, Adelaide, South Australia, Australia. 5. Department of Infectious Diseases, Women's and Children's Hospital, Adelaide, South Australia, Australia. 6. Department of Infectious Diseases, Royal Children's Hospital Melbourne, Victoria, Australia. 7. Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, Victoria, Australia. 8. Department of Microbiology, Royal Children's Hospital, Melbourne, Victoria, Australia. 9. Department of Immunology, Royal Children's Hospital, Melbourne, Victoria, Australia. 10. Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
Abstract
BACKGROUND: Invasive pneumococcal disease (IPD) is associated with significant morbidity and mortality in children. Universal pneumococcal conjugate vaccination has changed the epidemiology of IPD. In vaccinated children, IPD can be a marker of an underlying immunodeficiency. METHODS: This is a retrospective audit of children younger than 18 years with IPD admitted to 2 tertiary pediatric hospitals in Australia between 2011 and 2017. Data on predisposing conditions, immunologic evaluation, pneumococcal serotype, antibiotic susceptibility and treatment were collected. RESULTS: During the 7-year period, there were 131 presentations with IPD in 127 children; 3 children had recurrent IPD. Patients presented with sepsis (41%), empyema (29%), meningitis (18%), mastoiditis (12%), pneumonia (10%) and septic arthritis (4%). In 19 (15%) presentations, risk factors for IPD were present, including malignancy, hematologic disorder, chronic liver disease, chronic kidney disease and cochlear implant. Pneumococcal serotypes were determined in 78/131 (60%) of presentations: the most frequent serotypes were 19A (19%), 3 (13%), 7F (10%) and 19F (8%) and non-vaccine serotypes 22F (8%), 35B (6%), 15A (4%) and 38 (4%). Overall, 11% of isolates were non-susceptible to ceftriaxone. Only 36 patients (32%) had an immunologic evaluation, and 4 patients had proven or probable immunodeficiency. CONCLUSION: Although pneumococcal conjugate vaccine serotypes 19A, 3, 19F and 7F remain frequent causes of IPD, non-vaccine serotypes are emerging. Our data support vancomycin treatment for children with pneumococcal meningitis given 11% of our isolates were not susceptible to ceftriaxone. It is important to consider underlying conditions predisposing to IPD in a population with high rates of pneumococcal vaccination.
BACKGROUND:Invasive pneumococcal disease (IPD) is associated with significant morbidity and mortality in children. Universal pneumococcal conjugate vaccination has changed the epidemiology of IPD. In vaccinated children, IPD can be a marker of an underlying immunodeficiency. METHODS: This is a retrospective audit of children younger than 18 years with IPD admitted to 2 tertiary pediatric hospitals in Australia between 2011 and 2017. Data on predisposing conditions, immunologic evaluation, pneumococcal serotype, antibiotic susceptibility and treatment were collected. RESULTS: During the 7-year period, there were 131 presentations with IPD in 127 children; 3 children had recurrent IPD. Patients presented with sepsis (41%), empyema (29%), meningitis (18%), mastoiditis (12%), pneumonia (10%) and septic arthritis (4%). In 19 (15%) presentations, risk factors for IPD were present, including malignancy, hematologic disorder, chronic liver disease, chronic kidney disease and cochlear implant. Pneumococcal serotypes were determined in 78/131 (60%) of presentations: the most frequent serotypes were 19A (19%), 3 (13%), 7F (10%) and 19F (8%) and non-vaccine serotypes 22F (8%), 35B (6%), 15A (4%) and 38 (4%). Overall, 11% of isolates were non-susceptible to ceftriaxone. Only 36 patients (32%) had an immunologic evaluation, and 4 patients had proven or probable immunodeficiency. CONCLUSION: Although pneumococcal conjugate vaccine serotypes 19A, 3, 19F and 7F remain frequent causes of IPD, non-vaccine serotypes are emerging. Our data support vancomycin treatment for children with pneumococcal meningitis given 11% of our isolates were not susceptible to ceftriaxone. It is important to consider underlying conditions predisposing to IPD in a population with high rates of pneumococcal vaccination.
Authors: Alan Basset; Emma Wall; Daniela M Ferreira; Richard Malley; Elena Mitsi; Chloe Deshusses; Raecliffe Daly; Sherin Pojar; Jesús Reiné; Jose Afonso Guerra-Assuncao; Brigitte Denis; Simon P Jochems; Robert Heyderman; Jeremy Brown; Ying-Jie Lu Journal: Infect Immun Date: 2022-06-08 Impact factor: 3.609