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Pediatr Infect Dis J. 2020 Jan;39(1):1-6. doi: 10.1097/INF.0000000000002489.

Changing Epidemiology and Predisposing Factors for Invasive Pneumococcal Disease at Two Australian Tertiary Hospitals.

Author information

1
From the Department of Paediatric Infectious Diseases, St Mary's Hospital, Imperial College Healthcare Trust, London, United Kingdom.
2
Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.
3
Department of Immunology, Women's and Children's Hospital, Adelaide, South Australia, Australia.
4
Department of General Medicine, Paediatrics, Women's and Children's Hospital, Adelaide, South Australia, Australia.
5
Department of Infectious Diseases, Women's and Children's Hospital, Adelaide, South Australia, Australia.
6
Department of Infectious Diseases, Royal Children's Hospital Melbourne, Victoria, Australia.
7
Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, Victoria, Australia.
8
Department of Microbiology, Royal Children's Hospital, Melbourne, Victoria, Australia.
9
Department of Immunology, Royal Children's Hospital, Melbourne, Victoria, Australia.
10
Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.

Abstract

BACKGROUND:

Invasive pneumococcal disease (IPD) is associated with significant morbidity and mortality in children. Universal pneumococcal conjugate vaccination has changed the epidemiology of IPD. In vaccinated children, IPD can be a marker of an underlying immunodeficiency.

METHODS:

This is a retrospective audit of children younger than 18 years with IPD admitted to 2 tertiary pediatric hospitals in Australia between 2011 and 2017. Data on predisposing conditions, immunologic evaluation, pneumococcal serotype, antibiotic susceptibility and treatment were collected.

RESULTS:

During the 7-year period, there were 131 presentations with IPD in 127 children; 3 children had recurrent IPD. Patients presented with sepsis (41%), empyema (29%), meningitis (18%), mastoiditis (12%), pneumonia (10%) and septic arthritis (4%). In 19 (15%) presentations, risk factors for IPD were present, including malignancy, hematologic disorder, chronic liver disease, chronic kidney disease and cochlear implant. Pneumococcal serotypes were determined in 78/131 (60%) of presentations: the most frequent serotypes were 19A (19%), 3 (13%), 7F (10%) and 19F (8%) and non-vaccine serotypes 22F (8%), 35B (6%), 15A (4%) and 38 (4%). Overall, 11% of isolates were non-susceptible to ceftriaxone. Only 36 patients (32%) had an immunologic evaluation, and 4 patients had proven or probable immunodeficiency.

CONCLUSION:

Although pneumococcal conjugate vaccine serotypes 19A, 3, 19F and 7F remain frequent causes of IPD, non-vaccine serotypes are emerging. Our data support vancomycin treatment for children with pneumococcal meningitis given 11% of our isolates were not susceptible to ceftriaxone. It is important to consider underlying conditions predisposing to IPD in a population with high rates of pneumococcal vaccination.

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