Analysis of clinical features and risk factors of mortality in children with Streptococcal pneumoniae bloodstream infection

Abstract

Objective To explore the susceptible factors, clinical features and risk factors of mortality in patient with Streptococcus pneumoniae(Sp)bloodstream infections. Methods A total of 57 patients with Sp bloodstream infection were enrolled.The data of clinical information including gender, age, source of infection, underlying disease, drug sensitivity to some bacterial strain and serotype were retrospectively analyzed.According to the prognosis on 28 day, patients were divided into death group (n=15)and recovery group (n=40). The risk factors of mortality were analyzed by adopting multivariate Logistic regression analysis. Results Fifty-seven cases were enrolled, in which the rate of male and female was 21, and the majority (51 cases, 89.5%)were under 5 years old, including 31 cases (54.4%)of community acquired infection.Fever was the most frequent presented symptom.Complications included 39 cases (68.4%)of pneumonia, 13 cases (22.8%)of meningitis.Twenty-eight cases (49.1%)had underlying diseases, including 5 cases (17.2%)of nephrotic syndrome, 4 cases (13.8%)of acute lymphocytic leukemia, 4 cases (13.8%)of neuroblastoma and 15 cases (26.3%)of other diseases.Viral coinfection included 9 cases (15.8%)of adenovirus and 3 cases (5.3%)of rotavirus.The results of drug sensitivity for 53 strain Sp revealed that the non-susceptible rate of penicillin was 43.4%, while multiple drug resistance was 88.7%.Twenty-one strains had serotype results, and all of them were covered by Pneumococcal 13-Valent Conjugate Vaccine(PCV13)except 1 strain of 11A.The death group contained 15 patients and the death rate was 26.3%, while 40 patients in recovery group.The independent risk factors of mortality were complicated with meningitis(OR=7.611, 95%CI: 1.476-39.238, P=0.015)or septic shock (OR=29.719, 95%CI: 2.231-395.952, P=0.010). Conclusion The patients with Sp bloodstream infection, under 5 years old, having underlying diseases, are susceptible to Sp bloodstream infection, and also can have coinfection with other virus.Meningitis and septic shock are the risk factors of mortality.The majority of serotype strains belong to PCV13. Key words: Streptococcus pneumoniae; Bloodstream infection; Clinical features; Risk factors of mortality