Outcome of Severe Bacterial Pneumonia in the Era of Pneumococcal Vaccination

Abstract

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.

Staphylococcus aureus Community-acquired Pneumonia in Children After 13-Valent Pneumococcal Vaccination (2008–2018): Epidemiology, Clinical Characteristics and Outcomes

“…4 Because of the stable prevalence of S. aureus CAP, recent updates to guidelines recommend maintaining aminopenicillins as first-line treatment for most cases of CAP, since they remain highly active against S. pyogenes and S. pneumoniae. 8,9,18 The prevalence of MRSA among children with S. aureus CAP in our study (26.5%) was comparable to that seen in childhood CAP in various European countries, 4,6,7 but lower than reported in other studies performed in countries with a higher burden of MRSA. [19][20][21][22] A recent study describing the epidemiology of Spanish children colonized by S. aureus reported a prevalence of MRSA of 4.4% among S. aureus isolates.…”

“…25,30,30 A Spanish study showed results similar to ours, with comparable outcomes among children with S. pneumoniae and S. aureus CAP, whereas S. pyogenes was associated with a higher risk for complications. 7 This higher morbidity associated with S. pyogenes CAP than with S. pneumoniae CAP was also reported in Israel. 31 In our study, it is noteworthy that patients with S. aureus CAP, which mainly affect infants, were younger than those with CAP caused by other bacteria.…”

“…2,3 Additionally, a relative increase seems to have occurred in the prevalence of other bacteria, such as Streptococcus pyogenes and Staphylococcus aureus , thus diminishing the relevance of S. pneumoniae . 4–7…”

“…2,3 Additionally, a relative increase seems to have occurred in the prevalence of other bacteria, such as Streptococcus pyogenes and Staphylococcus aureus, thus diminishing the relevance of S. pneumoniae. [4][5][6][7] Recognition and management of S. aureus CAP in children is challenging. Most national guidelines on pediatric CAP do not recommend routine empirical coverage of S. aureus.…”

Study of Vitamin D Status in Pneumonia among Children between 6 Months to 3 Years of Age

“…Death in female children admitted with very severe pneumonia was 4 times higher than that reported in males. Similarly, in a study by Del Rosal et al, [29] in Madrid, Spain. Some authors explained this notion may be due to care-seeking behaviors of the parents of children with pneumonia prior to hospitalization superior to males [28].…”