Abstract
Streptococcus pneumoniae remains the leading causative pathogen in pediatric pneumonia and bacteremia throughout the world. The invasive pneumococcal disease (IPD) is known as isolation of S. pneumoniae from a normally sterile site (e.g., blood, cerebrospinal fluid, synovial fluid, pericardial fluid, pleural fluid, or peritoneal fluid). The aim of this study is to survey the clinical manifestations and laboratory results of IPD and identify the prognostic factors of mortality. From January 2001 to December 2006, a retrospective review of chart was performed in a teaching hospital in Taipei. The hospitalized pediatric patients with the diagnosis of pneumonia, arthritis, infectious endocarditis, meningitis or sepsis were recruited. Among them, 50 patients were pneumococcal infections proved by positive culture results or antigen tests. Clinical manifestations, laboratory data and hospitalization courses were analyzed. The median age was 3.5-year-old and there were 30 male patients (60%). Eight patients (16%) had underlying disease such as leukemia or congenital heart disease. Hemolytic uremic syndrome (HUS) was observed in ten patients and extracorporeal membrane oxygenation (ECMO) was performed in three patients. Leukocytosis, elevated C-reactive protein and AST level were noted in most of the patients. The overall mortality rate was 10%. We found that leukopenia, thrombocytopenia and high CRP level were significant predictors for mortality. In conclusion, S. pneumoniae remains an important health threat worldwide and IPD is life-threatening with high mortality rate. We found leukopenia, thrombocytopenia, and high CRP levels to be associated with mortality in pediatric IPD, and these factors are worthy of special attention at admission. Although we failed to identify a statistically significant prognostic factor in multivariate analysis due to relatively small sample size, we suggest an aggressive antibiotic treatment in patients with these factors at admission. Further large-scale studies are warranted.
Highlights
Streptococcus pneumoniae, a Gram-positive diplococcus, remains the leading causative pathogen in pediatric pneumonia and bacteremia worldwide (Jroundi et al, 2014; Tan, 2012)
Invasive pneumococcal disease (IPD) was more common in cold seasons (36 patients, 72% in autumn and winter) and pneumonia was diagnosed in 46 patients (92%)
Laboratory data, and hospital course between the survival and mortality groups, we found that leukopenia, thrombocytopenia, and high C-reactive protein (CRP) levels (CRP > 20 mg/dL) were significant predictors for mortality (Table 2)
Summary
Streptococcus pneumoniae, a Gram-positive diplococcus, remains the leading causative pathogen in pediatric pneumonia and bacteremia worldwide (Jroundi et al, 2014; Tan, 2012). Invasive pneumococcal disease (IPD) is defined as isolation of S. pneumoniae from a normally sterile site (e.g., blood, cerebrospinal fluid (CSF), synovial fluid, pericardial fluid, pleural fluid, or peritoneal fluid) (Levine et al, 1999). The mortality rate associated with IPD is high, ranging from approximately 5.3–27.5%, and identification of high-risk groups is important (Berjohn et al, 2008; Chen et al, 2009; Gomez-Barreto et al, 2010; Marrie et al, 2011; Ruckinger et al, 2009; Rueda et al, 2010; Shariatzadeh et al, 2005; Ulloa-Gutierrez et al, 2003). Some factors associated with outcome include breastfeeding, passive smoking, antimicrobial resistance, pneumococcal serotype, and prompt use of antibiotics (Berjohn et al, 2008; Haddad et al, 2008; Ruckinger et al, 2009; Tan, 2012). The aim of this study was to survey the clinical manifestations and laboratory results of IPD in children and identify the prognostic factors of mortality
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