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Invasive pneumococcal infection in children
1Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan. ncc88@ms2.mmh.org.tw
Insights
Invasive pneumococcal infections in children, particularly meningitis, are linked to poor outcomes and rising penicillin resistance. Early antibiotic treatment is crucial for better results in pediatric cases.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Streptococcus pneumoniae infections pose significant mortality and morbidity risks, affecting multiple organs.
- Invasive pneumococcal infections are a serious concern in pediatric populations.
- Previous studies highlight the need to understand trends in pediatric pneumococcal disease.
Purpose of the Study:
- To review invasive pneumococcal infections in children treated at a Taipei teaching hospital from 1984 to 1998.
- To identify risk factors, clinical presentations, and outcomes associated with pediatric invasive pneumococcal disease.
- To analyze trends in antibiotic resistance, specifically penicillin resistance, over the study period.
Main Methods:
- Retrospective review of 81 pediatric patients hospitalized with invasive pneumococcal infection.
- Data collection included patient demographics, clinical manifestations, infection sites, and outcomes.
- Statistical analysis, including multi-regression, was used to identify factors affecting prognosis and antibiotic resistance patterns.
Main Results:
- The majority of patients (81.7%) were under 5 years old, with infections peaking from October to March.
- Common presentations included sepsis (60), meningitis (28), pneumonia with pleural effusion (27), and arthritis (4), with 38 patients having multiple infection sites.
- Mortality was 16.0% and severe sequelae occurred in 24.7%; meningitis and complications independently predicted poor outcomes.
- Penicillin-resistant strains increased significantly from 1990 onwards, comprising four-fifths of infections in the final two study years.
Conclusions:
- Invasive pneumococcal infections in children carry a substantial risk of poor prognosis and severe sequelae.
- The rising prevalence of penicillin-resistant Streptococcus pneumoniae strains necessitates careful consideration of antibiotic strategies.
- Prompt and appropriate antibiotic therapy is essential for improving outcomes in pediatric patients with invasive pneumococcal infections.
Abstract:
Streptococcus pneumoniae infections can involve multiple organs and cause high mortality and morbidity. In this retrospective study, we reviewed patients with invasive pneumococcal infection in the pediatric department of a teaching hospital in Taipei. From 1984 to 1998, 81 children with invasive pneumococcal infection were hospitalized. Twenty-eight patients had meningitis, 27 had pneumonia with pleural effusion, 60 had sepsis, and 4 had arthritis. Thirty-eight patients had more than one site of infection. Most of our patients (81.7%) were below 5 years of age. Pneumococcal infections were more common from October to March. Eight patients had a history of trauma that correlated with the site of infection. Thirteen patients (16.0%) expired and 20 (24.7%) had severe sequelae. Multi-regression analysis found that meningitis and complications were independent variables that affected the outcome. The percentage of penicillin-resistant strains increased beginning in 1990 and accounted for about four-fifths of the infections in the final 2 years of the study. Since invasive pneumococcal infections in children may have a poor prognosis and penicillin-resistant strains have become increasingly common, early and adequate antibiotic therapy should be given as soon as possible.