Clinical Features of Pediatric Pneumococcal Bacteremia in Mid-Taiwan: A Single-Institute Experience

Ming-Jenn Lee ； Wei-Ching Lin ； Chih-Lun Hung ； Chien-Sheng Cheng ； Chien-Heng Lin

《中華民國兒童胸腔醫學會雜誌》 8卷3期 (2012/09) Pp. 85-91

https://doi.org/10.6322/JPRD.201209_8(3).0004

並列摘要

Background: Streptococcus pneumoniae is a common cause of bacterial infections in children. Infants younger than 2 years of age and individuals with immune abnormalities are most susceptible to pneumococcal infections. This study aimed to analyze the epidemiology of pneumococcal bacteremia in one regional teaching hospital in central Taiwan.Materials and Methods: The medical records of patients diagnosed with pneumococcal bacteremia between May 2007 and April 2012 were retrieved. All identified strains were of serogroups 6A, 14, 19A, 19F, and 23F. The results of antibiotic-sensitivity tests were evaluated. The cutoff for penicillin resistance was a minimum inhibitory concentration (MIC) of penicillin of ＞2 μg/mL. Data on age distribution, seasonal distribution, and antibiotic resistance of the bacteria were obtained by a retrospective chart review.Results: Fifteen patients (seven boys and eight girls; median age, 3.1 years; range, 1.4 - 9.3 years) had blood culture-confirmed Streptococcus pneumoniae infections. The major serotype was 19F, accounting for 6 cases (40.0%), followed by 23F, 3 cases (20.0%); 19A, 2 cases (13.3%); 6A, 2 cases (13.3%); and 14, 2 cases (13.3%). Ten patients were aged 2-5 years; five were aged ＞5 years, and only one was aged ＜2 years. All strains, except one, were resistant to penicillin. Two were susceptible to sulfamethoxazole/trimethoprim, and all were susceptible to third-generation cephalosporins and vancomycin. Leukocytosis was present in 53.3% of the children, and the C-reactive protein level was ＞5 mg/dL in 40%. Two children developed pleural effusion requiring drainage, and one of them had empyema. Two children died of meningitis or acute respiratory distress syndrome. The mortality rate in our study was 13.3%.Conclusion: Most children with pneumococcal bacteremia in our study were aged 2-5 years. The prevalence of antibiotic resistance was very high, with approximately 86% resistance to sulfamethoxazole/trimethoprim and 93% resistance to penicillin. None of our patients had received polyvalent pneumococcal vaccines. Prompt polyvalent pneumococcal vaccinations to reduce the incidence of serious pneumococcal disease are important.

並列關鍵字

Streptococcus pneumonia ； bacteremia ； children