Invasive pneumococcal infection in urban Thai children: a 10-year review

Area of Science:

• Pediatrics
• Infectious Diseases
• Microbiology

Background:

• Invasive pneumococcal infections (IPIs) pose a significant threat to children globally.
• Understanding disease patterns and antimicrobial resistance is crucial for effective management.
• Thailand has specific demographic and healthcare contexts influencing IPIs.

Purpose of the Study:

• To determine the incidence, clinical features, and antimicrobial susceptibility of IPIs in children treated at a major Thai hospital.
• To analyze demographic characteristics and identify risk factors associated with IPIs.
• To assess drug resistance patterns, including penicillin-nonsusceptible Streptococcus pneumoniae (PNSSP).

Main Methods:

• Retrospective review of medical records for children (<18 years) diagnosed with IPIs between 1998 and 2007.
• Data collection included demographics, clinical presentations, laboratory findings, and antimicrobial susceptibility testing results.
• Analysis of culture-proven cases from the Queen Sirikit National Institute of Child Health (QSNICH).

Main Results:

• An estimated incidence of 17 IPIs per 100,000 patients was observed.
• Bacteremia, meningitis, and pneumonia were the primary diagnoses.
• Penicillin-nonsusceptible S. pneumoniae (PNSSP) accounted for 54.8% of meningitis cases and 25.3% of non-meningitis cases.
• High rates of resistance to cefotaxime and ceftriaxone were noted among PNSSP, but all isolates remained susceptible to vancomycin.
• The overall case fatality rate was 12.3%, with a disproportionately higher rate (23.1%) among HIV-infected children.

Conclusions:

• The incidence of IPIs at QSNICH is relatively low, but the case fatality rate is concerningly high.
• HIV infection is a significant risk factor associated with increased mortality from IPIs.
• The prevalence of antimicrobial resistance, particularly PNSSP, highlights the need for ongoing surveillance and appropriate treatment strategies.