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Early clinical predictors for the prognosis of invasive pneumococcal disease
Shuiyan Wu1, Xubei Guo1, Zhong Xu1
1Pediatric Intensive Care Unit, Children's Hospital of Soochow University, Suzhou, Jiangsu, China.
Insights
Early signs like fever, vomiting, and lethargy in children with invasive pneumococcal disease (IPD) predict mortality. Prompt antibiotic use and pneumococcal conjugate vaccine (PCV) immunization are crucial for improving outcomes.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Medicine
Background:
- Invasive pneumococcal disease (IPD) poses a significant mortality risk in children.
- Early clinical indicators of IPD prognosis are not well-established.
Purpose of the Study:
- To identify early clinical manifestations and risk factors associated with mortality in hospitalized children with IPD.
- To analyze the impact of serotype, antibiotic susceptibility, and vaccination status on IPD outcomes.
Main Methods:
- Retrospective analysis of 97 hospitalized children with laboratory-confirmed IPD in Suzhou, China.
- Collection and evaluation of demographic data, clinical features, pathogen characteristics, and treatment outcomes.
Main Results:
- Mortality rate for IPD was 17.5%, with 53.6% of deaths occurring in children under two years old.
- Independent risk factors for in-hospital mortality included hyperpyrexia, vomiting, anorexia, lethargy, and poor extremity perfusion.
- Antimicrobial sensitivity and serotype coverage by pneumococcal conjugate vaccines (PCV7 and PCV13) were associated with survival rates.
Conclusions:
- Recurrent hyperpyrexia, vomiting, anorexia, lethargy, and poor perfusion are critical early predictors of mortality in pediatric IPD.
- Effective antibiotic therapy and widespread PCV immunization are essential strategies to reduce IPD-related mortality in children.
Background:
Risk factors related to mortality due to invasive pneumococcal disease (IPD) have been unveiled previously, but early clinical manifestations of IPD based on prognosis remain uncovered.
Methods:
The demographic characteristics, clinical features, serotype, antibiotic susceptibility, and outcomes of 97 hospitalized children with laboratory-confirmed IPD from Suzhou, China, were collected and analyzed retrospectively.
Results:
The median age was 0.69 (0.49-1.55) years in the non-survivor group compared with 2.39 (0.90-3.81) years in the survivor group. The mortality of 97 children with laboratory-confirmed IPD was 17.5% (17/97), and 53.6% of them were aged less than 2 years. Pathogens were mainly from the blood and cerebrospinal fluid, and sepsis was the most frequent type. Statistically significant differences were found in hyperpyrexia, vomiting, anorexia, lethargy, poor perfusion of extremities, Hb level, and Plt count between the nonsurvival and survival groups. Further, the multivariate regression analysis showed that early signs, including hyperpyrexia, vomiting, anorexia, lethargy, and poor perfusion of extremities, were independent risk factors for the in-hospital mortality of children with laboratory-confirmed IPD. The mortality was also associated with antimicrobial sensitivity in pneumococcal isolates. The microbes in 1/17 (5.9%) children who were prescribed an antibiotic showed antimicrobial sensitivity in the nonsurvival group, compared with 21/80 (26.3%) children who survived. The most common serotypes identified were 6B (35.3%, 6/17), 14 (23.5%, 4/17), 19F (23.5%, 4/17), 19A (5.9%, 1/17), 23F (5.9%, 1/17), and 20 (5.9%, 1/17) in the nonsurvival group. The coverage of IPD serotypes of the 7-valent pneumococcal conjugate vaccine (PCV7) was 88.2% (15/17), while that of the 13-valent S. pneumoniae vaccine (PCV13) was 94.1% (16/17) of the coverage in the nonsurvival group.
Conclusions:
Recurrent hyperpyrexia, vomiting, anorexia, lethargy, and poor perfusion of extremities in the early stage were independent predictors for the in-hospital mortality of children with laboratory-confirmed IPD. Appropriate use of antibiotics and PCV immunization were the keys to improve the outcome of IPD.
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