Increasing Rates of Pediatric Empyema and Disease Severity With Predominance of Serotype 3 S. pneumonia

Haggie, Stuart; Fitzgerald, Dominic A.; Pandit, Chetan; Selvadurai, Hiran; Robinson, Paul D.; Gunasekera, Hasantha; Britton, Philip N

doi:10.1097/inf.0000000000002474

Cited by 17 publications

(23 citation statements)

References 35 publications

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“…Almost 60% of children (38/64) developed complications, mainly pleural effusion/empyema (34/64, 53%). Twenty-nine patients [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31], p = 0.015) and had a longer hospital stay (17 [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] days vs. 4.5 [1][2][3][4][5][6][7], p < 0.001).…”

Section: Resultsmentioning

confidence: 98%

“…Most studies that have compared children with S. pneumoniae and S. pyogenes CAP have only included patients with empyema. Among them, S. pyogenes is also associated with a more acute and severe presentation (4,6). These findings are important as invasive S. pyogenes infections are rising in the last decades worldwide (16)(17)(18)(19), and pediatric parapneumonic pleural effusion in increasingly caused by S. pyogenes (5,14,20).…”

Section: Discussionmentioning

confidence: 99%

“…Streptococcus pneumoniae is the most common typical bacterial cause of pneumonia in children (2,3) but Staphylococcus aureus and Streptococcus pyogenes are becoming increasingly frequent, particularly among children requiring hospitalization and/or presenting with complications such as necrosis, parapneumonic pleural effusion and empyema (4)(5)(6)(7)(8). However, few studies have directly compared the clinical characteristics and outcomes of CAP caused by these bacteria according to the etiology.…”

Section: Introductionmentioning

confidence: 99%

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Outcome of Severe Bacterial Pneumonia in the Era of Pneumococcal Vaccination

et al. 2020

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Introduction: After the introduction of pneumococcal conjugate vaccines, community-acquired pneumonia (CAP) caused by Streptococcus pneumoniae has decreased whereas Staphylococcus aureus and Streptococcus pyogenes could be increasing. These bacteria have been associated with high rates of complications.Aims: (1) To describe the characteristics of pediatric bacterial CAP requiring hospitalization. (2) To compare outcomes according to causative microorganisms. (3) To analyze changes in bacterial CAP rate and etiology over time.Patients and Methods: Retrospective single-center study of inpatients aged 1 month-16 years with culture-confirmed bacterial CAP in 2010-2018 in Madrid, Spain.Results: We included 64 cases (42 S. pneumoniae, 13 S. pyogenes and 9 S. aureus). Culture-confirmed CAP represented 1.48-2.33/1,000 all-cause pediatric hospital admissions, and its rate did not vary over time. However, there was a significant decrease in pneumococcal CAP in the last 3 years of the study (78% of CAP in 2010–2015 vs. 48% in 2016-18, p = 0.017). Median hospital stay was 10.5 days (interquartile range 5-19.5), 38 patients (59%) developed complications and 28 (44%) were admitted to the intensive care unit. Outcomes were similar among children with S. pneumoniae and S. aureus CAP, whereas S. pyogenes was associated with a higher risk for complications (OR 8 [95%CI 1.1-57.2]) and ICU admission (OR 7.1 [95%CI 1.7-29.1]) compared with pneumococcal CAP.Conclusion: In a setting with high PCV coverage, culture-confirmed bacterial CAP did not decrease over time and there was a relative increase of S. pyogenes and S. aureus. Children with CAP caused by S. pyogenes were more likely to develop complications.

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Section: Resultsmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Outcome of Severe Bacterial Pneumonia in the Era of Pneumococcal Vaccination

et al. 2020

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“…[1][2][3][4][5][6][7][8][9][10] In addition, the transvaginal route, having typical physical and physiological benefits, [1][2][3][4][5][6][11][12][13][14][15][16] makes it the safest, as well as an immensely popular method. [1][2][3]6,[11][12][13][14][15][17][18][19][20][21][22][23][24][25][26] However, even a decade after its inception, it continues to be fraught with diverse technical hurdles such as spatial constraints, inadvertent vaginal gas-leak, compelling requirements for complex instrumentation, scarce availability and affordability, and a steep learning curve, to name a few. 7,[13][14][15][16][17][18][19]…”

Section: Introductionmentioning

confidence: 99%

“…It commonly occurs secondary to bacterial pneumonia. 1,2 Globally, its incidence in children is increasing despite improvement in antimicrobial treatment and vaccination, 3 and is a common cause of morbidity. 4 Parapneumonic effusion/pleural empyema develop in 28% of children presenting with community acquired pneumonia.…”

Section: Introductionmentioning

confidence: 99%

Open pleural decortication for the late stage empyema thoracis in children: a retrospective observational study from a tertiary hospital of eastern Nepal

et al. 2020

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The management of late-stage empyema thoracis requires surgical intervention. We performed a retrospective descriptive analysis of open pleural decortication for late stage empyema thoracis in 55 children (age ≤ 15 years; median age = 6 years; age range = 1–15 years; 40 [72.7%] boys) over 42 months. The median time to thoracotomy from the onset of symptoms was 24 days, and the median duration of hospital stay before and after surgery was 15 and 4 days, respectively. Three (5.5%) patients had necrotising pneumonia, requiring debridement; 4 (7.3%) patients had superficial surgical site infection; 12 (21.8%) patients had perioperative pus culture positive for bacteria; and 3 (5.5%) patients had tubercular aetiology. There was no operative mortality. At median follow-up of 18 months, all patients are in good general health. Open pleural decortication leads to rapid resolution of symptoms and reduces hospital stay in paediatric late-stage empyema thoracis.

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Necrotizing pneumonia among Italian children in the pneumococcal conjugate vaccine era

Carloni¹,

Ricci

Rubino

et al. 2021

Pediatric Pulmonology

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Background Necrotizing pneumonia (NP) is a severe complication of community‐acquired pneumonia. The impact of 13‐valent pneumococcal conjugate vaccine (PCV13) on the epidemiology of NP in children has not been assessed. Patients and methods Medical records of children less than 18 years admitted with NP to two pediatric hospitals in Italy between 2005 and 2019 were reviewed. The following four periods were defined: 2005–2010 (pre‐PCV13), 2011–2013 (early post‐PCV13), 2014–2016 (intermediate post‐PCV13), and 2017–2019 (late post‐PCV13). Results Forty‐three children (median age, 44 months) were included. Most of them (93%) were previously healthy. No differences in age, sex, season of admission, comorbidity, clinical presentation, or hospital course were identified between pre‐PCV13 and post‐PCV13 periods. A significant decrease in the rate of NP‐associated hospitalizations was found between the early (1.5/1000 admissions/year) and the intermediate (0.35/1000 admissions/year) post‐PCV13 period (p = .001). An increased trend in admissions was found thereafter. Streptococcus pneumoniae was the most common agent detected in both periods (pre‐PCV13: 11/18, 61%; post‐PCV13: 13/25, 52%). Serotype 3 was the most common strain in both periods (pre‐PCV13: 3/11, 27%; post‐PCV13; 4/13, 31%). There were no changes in the etiology over time, but most patients with Streptococcus pyogenes or Staphylococcus aureus infection were admitted during the post‐PCV13 period. Conclusions The hospitalization rate for NP in children decreased a few years after the implementation of PCV13 immunization in Italy. However, an increased trend in admissions was found thereafter. S. pneumoniae was the most frequent causal agent in both pre‐ and post‐PCV13 periods. Pneumococcal serotypes were mainly represented by Strain 3.

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Increasing Rates of Pediatric Empyema and Disease Severity With Predominance of Serotype 3 S. pneumonia

Cited by 17 publications

References 35 publications

Outcome of Severe Bacterial Pneumonia in the Era of Pneumococcal Vaccination

Outcome of Severe Bacterial Pneumonia in the Era of Pneumococcal Vaccination

Open pleural decortication for the late stage empyema thoracis in children: a retrospective observational study from a tertiary hospital of eastern Nepal

Necrotizing pneumonia among Italian children in the pneumococcal conjugate vaccine era

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