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PeerJ. 2017 Jan 25;5:e2941. doi: 10.7717/peerj.2941. eCollection 2017.

Retrospective study of prognostic factors in pediatric invasive pneumococcal disease.

Chiu NC#1,2,3, Chi H#1,2,3, Peng CC1,2,3, Chang HY1,4, Huang DT1,2, Chang L1,2, Lei WT5, Lin CY5.

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Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan.
MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan.
MacKay Medical College, New Taipei, Taiwan.
Department of Medical Technology, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan.
Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan.
Contributed equally


Streptococcus pneumoniae remains the leading causative pathogen in pediatric pneumonia and bacteremia throughout the world. The invasive pneumococcal disease (IPD) is known as isolation of S. pneumoniae from a normally sterile site (e.g., blood, cerebrospinal fluid, synovial fluid, pericardial fluid, pleural fluid, or peritoneal fluid). The aim of this study is to survey the clinical manifestations and laboratory results of IPD and identify the prognostic factors of mortality. From January 2001 to December 2006, a retrospective review of chart was performed in a teaching hospital in Taipei. The hospitalized pediatric patients with the diagnosis of pneumonia, arthritis, infectious endocarditis, meningitis or sepsis were recruited. Among them, 50 patients were pneumococcal infections proved by positive culture results or antigen tests. Clinical manifestations, laboratory data and hospitalization courses were analyzed. The median age was 3.5-year-old and there were 30 male patients (60%). Eight patients (16%) had underlying disease such as leukemia or congenital heart disease. Hemolytic uremic syndrome (HUS) was observed in ten patients and extracorporeal membrane oxygenation (ECMO) was performed in three patients. Leukocytosis, elevated C-reactive protein and AST level were noted in most of the patients. The overall mortality rate was 10%. We found that leukopenia, thrombocytopenia and high CRP level were significant predictors for mortality. In conclusion, S. pneumoniae remains an important health threat worldwide and IPD is life-threatening with high mortality rate. We found leukopenia, thrombocytopenia, and high CRP levels to be associated with mortality in pediatric IPD, and these factors are worthy of special attention at admission. Although we failed to identify a statistically significant prognostic factor in multivariate analysis due to relatively small sample size, we suggest an aggressive antibiotic treatment in patients with these factors at admission. Further large-scale studies are warranted.


Invasive pneumococcal disease; Pneumococcus; Pneumonia; Prognostic factor; Streptococcus pneumoniae

Conflict of interest statement

The authors declare there are no competing interests.

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