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Risk factors for invasive pneumococcal disease in children: a population-based case-control study in North America
O S Levine1, M Farley, L H Harrison
1Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Insights
Risk factors for invasive pneumococcal disease in children include underlying illness and day care attendance. Breastfeeding may reduce risk, while antibiotic use and ear infections are linked to penicillin-resistant strains.
Area of Science:
- Pediatric infectious diseases
- Bacteriology
- Epidemiology
Background:
- Invasive pneumococcal disease (IPD) remains a significant global health concern in young children.
- Understanding risk factors is crucial for developing effective prevention strategies, especially for antibiotic-resistant strains.
Purpose of the Study:
- To identify key risk factors for invasive pneumococcal disease (IPD) in children aged 2 to 59 months.
- To investigate factors associated with penicillin-resistant *Streptococcus pneumoniae* infections.
Main Methods:
- A case-control study design was employed.
- Cases (n=187) with IPD were identified via population-based surveillance.
- Controls (n=280) were selected using random-digit telephone dialing.
Main Results:
- Underlying medical conditions and recent day care attendance (within 3 months) were strongly associated with IPD.
- Current breastfeeding showed a protective effect in infants aged 2-11 months (OR, 0.27; 95% CI: 0.08, 0.90).
- Penicillin-resistant *S. pneumoniae* infections were linked to day care, prior antibiotic use, and previous ear infections.
Conclusions:
- Underlying illnesses, day care attendance, and lack of breastfeeding are significant risk factors for IPD in children.
- Recent antibiotic use and prior infections are associated with penicillin-resistant *S. pneumoniae*, underscoring the need for judicious antibiotic prescribing.
Objective:
To identify risk factors for invasive pneumococcal disease, including penicillin-resistant infections, among children 2 to 59 months of age.
Design:
Case-control study.
Participants:
Patients with invasive pneumococcal infections identified by population-based surveillance (n = 187) and controls identified through random-digit telephone dialing (n = 280).
Outcome Measures:
Invasive pneumococcal disease was defined as isolation of Streptococcus pneumoniae from a normally sterile site. Patients 2 to 59 months of age who were residents of one of four active surveillance areas were included. S pneumoniae isolates were tested by broth microdilution. Isolates with a minimum inhibitory concentration to penicillin >/=2 microg/mL were considered resistant.
Results:
Invasive pneumococcal disease was strongly associated with underlying disease and with day care attendance in the previous 3 months. Among 2- to 11-month-olds, current breastfeeding was associated with a decreased likelihood of invasive pneumococcal disease (odds ratio, 0.27; 95% confidence interval: 0.08, 0.90). Penicillin-resistant infections were independently associated with day care attendance, at least one course of antibiotics, and at least one ear infection in the previous 3 months.
Conclusions:
This study shows the association of underlying illnesses, day care attendance, and lack of breastfeeding with risk of invasive pneumococcal disease in children. The association of recent antibiotic use and infection with penicillin-resistant S pneumoniae highlights the need to avoid unnecessary antibiotic use in children.