Pneumococcal bacteremia in children: an 8-year review in two hospitals in Barcelona

Abstract

In this study, 90 episodes of pneumococcal bacteremia that occurred over an 8-year period in two hospitals in Barcelona were analyzed retrospectively to determine the clinical and bacteriological characteristics of pneumococcal bacteremia, the risk factors for antibiotic resistance, the outcome, and the vaccine coverage. The mean age of the patients was 3.1 years and the male/female ratio was 1.7. The overall rates of penicillin-non-susceptible, cefotaxime-non-susceptible, and erythromycin-resistant isolates were 48.8, 24.4, and 25.5%, respectively. Antibiotic resistance was associated with children under the age of 2 years and with previous antibiotic treatment. The percentage of antibiotic resistance was higher in the nine episodes that occurred in patients with an underlying illness. The most prevalent serotypes identified were 1, 14, 6B, 18C, 5, and 19A. Serotypes 6A/B, 14, and 19A/F were isolated primarily from children under 2, whereas serotypes 1 and 5 were recovered more frequently from older children. Apparent relationships between serotypes 6A/B, 14, and 19A/F and occult bacteremia and between serotypes 1 and 5 and bacteremic pneumonia were confounded by the age variable. The proportion of bacteremic episodes preventable by all (7-valent, 9-valent, and 11-valent) of the conjugate pneumococcal vaccines was 60% in children under 2. In older children, the serotype coverage rate for the three formulations was 48, 87, and 87%, respectively. In summary, these data expand upon previous Spanish studies in which serotypes 1 and 5 were reported to be among the leading causes of severe systemic pneumococcal infections in children over 2, findings that should be taken into consideration when planning vaccine programmes.

Impact of the Pneumococcal Conjugate Vaccine in the Management of Highly Febrile Children Aged 6 to 24 Months in an Emergency Department

“…20 On the other hand, geographic variations in pneumococcal serotypes causing bacteremia have to be considered. 21 Ongoing surveillance is needed to assess whether reductions in vaccine-serotype invasive pneumococcal disease are sustained, and whether replacement disease will limit the substantial benefits of routine vaccination.…”

Controlling invasive pneumococcal disease: is vaccination of at-risk groups sufficient?

“…Nonetheless, most children hospitalised for IPD do not belong to any recognised at-risk group. In a US surveillance study, only 27% of hospitalised children had an underlying condition ( 11 ), while Canadian, French, Spanish and Finnish studies found that 23.2% ( 12 ), 16.7% ( 13 ), 10% ( 14 ) and 16% ( 15 ) of hospitalised children, respectively, had underlying conditions.…”

Pneumococcemia in children – a retrospective study before universal pneumococcal vaccinations

“…In children, less than 5% of pneumococcal pneumonias are bacteraemic with positive blood cultures (6,7). On the other hand, pneumonia has been present in a third of children with pneumococcal bacteraemia (3,4,8). In different studies, 18-60% of the pneumococcal bloodstream infections in children have been occult bacteraemias with no severe or localizing signs or symptoms (3,4,8).…”

“…On the other hand, pneumonia has been present in a third of children with pneumococcal bacteraemia (3,4,8). In different studies, 18-60% of the pneumococcal bloodstream infections in children have been occult bacteraemias with no severe or localizing signs or symptoms (3,4,8). An alternative term to occult pneumococcal bacteraemia is pneumococcemia.…”

“…Streptococcus pneumoniae is the most common cause of bacterial pneumonia and otitis media in children . In addition, S. pneumoniae is able to cause blood stream infections and invasive infections like meningitis . In children, less than 5% of pneumococcal pneumonias are bacteraemic with positive blood cultures .…”