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Invasive Streptococcus pneumoniae infections of children in central Taiwan
1Department of Pediatrics, Taichung Veterans General Hospital, Taiwan, ROC.
Insights
Childhood invasive pneumococcal infections (IPI) saw a dramatic rise in penicillin-nonsusceptible Streptococcus pneumoniae since 1995 in Taiwan. This led to increased mortality and long-term sequelae in survivors, particularly those with meningitis.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Childhood invasive pneumococcal infections (IPI) pose a significant public health concern.
- Streptococcus pneumoniae is a leading cause of bacterial meningitis, bacteremia, and pneumonia in children.
- Antimicrobial resistance in S. pneumoniae is a growing global challenge.
Purpose of the Study:
- To analyze the clinical features, outcomes, and antimicrobial resistance patterns of childhood IPI in central Taiwan.
- To investigate the trends in penicillin nonsusceptibility of Streptococcus pneumoniae isolates over time.
- To assess the impact of antimicrobial resistance on patient outcomes, including mortality and long-term sequelae.
Main Methods:
- Retrospective study of 95 clinical isolates from 72 children (<14 years) diagnosed with IPI between January 1990 and April 2000.
- Analysis of clinical data including infection types, diagnostic test sensitivities (Gram stain, latex agglutination), and patient outcomes.
- Evaluation of antimicrobial susceptibility patterns, focusing on the prevalence of penicillin nonsusceptible Streptococcus pneumoniae before and after 1995.
Main Results:
- The study identified various IPI manifestations, including bacteremia (51 patients), meningitis (28), and bacteremic pneumonia (14).
- Ancillary diagnostic tests showed sensitivities of 86.2% for Gram stain and 54.3% for latex agglutination.
- A dramatic increase in penicillin nonsusceptible Streptococcus pneumoniae was observed, rising from 5.6% before 1995 to 74.1% after 1995.
- Overall mortality rates increased significantly from 20.8% to 53.3% post-1995.
- Among survivors of pneumococcal meningitis, 52.6% experienced long-term sequelae.
Conclusions:
- Childhood invasive pneumococcal infections in central Taiwan have been increasingly caused by penicillin-nonsusceptible Streptococcus pneumoniae strains since 1995.
- This rise in antimicrobial resistance is associated with significantly higher mortality rates and a greater burden of long-term sequelae in affected children.
- Effective strategies for prevention and treatment are crucial to mitigate the impact of drug-resistant pneumococcal infections in pediatric populations.
Abstract:
We carried out a retrospective study on childhood invasive pneumococcal infections (IPI) diagnosed from the January 1990 through the April 2000 at a medical center in central Taiwan. Their clinical features, outcome of the patients and the resistance patterns of the isolates were analyzed. A total of 95 clinical isolates from 72 patients younger than 14 years of age were included in this study. Of these 72 patients, 51 had bacteremia, 28 meningitis, 14 bacteremic pneumonia, 12 pleural empyema, eight otitis media, four arthritis, three sinusitis, two periorbital abscesses, one deep neck infection, one psoas muscle abscess, one peritonitis, one urinary tract infection, and one cutaneous infection. Ancillary diagnostic tests, including Gram stain smears and latex agglutination tests, were applied and the sensitivities were 86.2% and 54.3%, respectively. The prevalence rate of penicillin nonsusceptible Streptococcus pneumoniae has increased dramatically since 1995 in central Taiwan, with rates of 5.6% and 74.1% before and after 1995, and the overall mortality rate was 20.8% and 53.3% respectively. Ten of 19 children (52.6%) with pneumococcal meningitis who survived had long-term sequelae.