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Six year multicenter surveillance of invasive pneumococcal infections in children
Sheldon L Kaplan1, Edward O Mason, EllenR Wald
1Pediatric Infectious Diseases Sections, Baylor College of Medicine, Houston, TX , USA. skaplan@bcm.tmc.edu
Insights
Antimicrobial resistance in invasive pneumococcal infections among children increased significantly over six years, particularly resistance to penicillin and ceftriaxone. These findings support pneumococcal conjugate vaccine recommendations for young children.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Clinical Epidemiology
Background:
- Invasive pneumococcal infections pose a significant threat to children's health.
- Monitoring antimicrobial susceptibility is crucial for effective treatment strategies.
Purpose of the Study:
- To track clinical and microbiologic features of invasive pneumococcal infections in children.
- To assess antimicrobial susceptibility trends of Streptococcus pneumoniae isolates.
Main Methods:
- A prospective, 6-year surveillance study (1993-1999) involving children with culture-proven invasive pneumococcal infections.
- Data collected from eight children's hospitals in the United States.
- Analysis of isolate characteristics, including serotype distribution and antimicrobial susceptibility.
Main Results:
- 2581 episodes of infection occurred in 2498 children; 29% had underlying conditions.
- Increasing proportions of isolates showed intermediate or resistant profiles to penicillin and ceftriaxone over the study period.
- By the final year, 37% of isolates were nonsusceptible to penicillin and 11% to ceftriaxone.
Conclusions:
- A steady increase in penicillin resistance and a trend toward ceftriaxone resistance were observed in pediatric pneumococcal isolates.
- Age and serotype distributions align with recommendations for pneumococcal conjugate vaccine administration in children aged 24-59 months.
Objective:
Monitor clinical and microbiologic features including antimicrobial susceptibility of invasive pneumococcal infections among children.
Design:
A 6-year (September, 1993, through August, 1999) prospective surveillance study of all invasive pneumococcal infections in children.
Patients:
Infants and children cared for at eight children's hospitals in the United States with culture-proved invasive pneumococcal infection.
Results:
During the 6-year period 2581 episodes of invasive pneumococcal infection occurred in 2498 children. Underlying conditions were present in 29% of the children. Of children without an underlying condition, 15% of the total infections occurred in those 25 to 60 months old. As the ages of the children advanced the proportion of cases classified as bacteremia declined, whereas the proportion classified as pneumonia increased. Also, as the ages of the children increased the proportion of isolates in serotypes/serogroups 1, 3 and 23 increased. whereas the proportion for serotype 14 diminished. During the 6 years of the study, there was a significant increase in the percentage of isolates intermediate or resistant to penicillin (P < 0.000001) or intermediate to ceftriaxone (P < 0.002). By the sixth year of the study, 37 and 11% of the isolates were nonsusceptible to penicillin or ceftriaxone, respectively. Antibiotic use in the 30 days before diagnosis of systemic pneumococcal infection occurred in 30 to 35% of the children for each of the 6 years. The overall case-fatality rate for children with systemic pneumococcal infection was 1.56%. Mortality was greatest in children >60 months old and in those with underlying conditions; mortality was not related to antibiotic susceptibility.
Conclusions:
The percentage of pneumococcal isolates recovered from children with systemic infection which were intermediate for penicillin or ceftriaxone or resistant to penicillin increased steadily during the 6-year period. There was also a trend toward increasing rates of resistance to ceftriaxone. The age and serogroup/serotype distributions of our patients support the recommendations to consider administration of the seven valent pneumococcal conjugate vaccine for all children 24 to 59 months old, with special consideration for selected groups.