Epidemiology of childhood invasive pneumococcal disease in Australia: a prospective cohort study.

IF 4.3 3区医学 Q1 PEDIATRICS

Archives of Disease in Childhood Pub Date : 2024-10-14 DOI:10.1136/archdischild-2024-327497

Linny Kimly Phuong, Abigail Cheung, Tiarni Templeton, Tamrat Abebe, Zanfina Ademi, Jim Buttery, Julia Clark, Theresa Cole, Nigel Curtis, Hazel Dobinson, Nadha Shahul Hameed, Hayley Hernstadt, Samar Ojaimi, Ella Grace Sharp, Praisoody Sinnaparajar, Sophie Wen, Andrew Daley, Brendan McMullan, Amanda Gwee

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引用次数: 0

Abstract

Background: The widespread use of pneumococcal conjugate vaccines (PCV) has changed the epidemiology of invasive pneumococcal disease (IPD) in children globally.

Methods: Multicentre prospective audit of IPD episodes from five paediatric hospitals in Australia over 5.5 years between 2016 and June 2021. Children (<18 years) with Streptococcus pneumoniae isolated from a sterile site were included.

Results: There were 377 IPD episodes in 375 children: 338 (90%) had received ≥3 PCV doses; 42 (11%) had IPD risk factors. The most common presentations were complicated pneumonia (254, 67%), bacteraemia (65, 17%) and meningitis (29, 8%). Five (1%) children died.Serotype information was available for 230 (61%) episodes; 140 (61%) were 13vPCV vaccine serotypes (VTs). The majority (85%) of episodes of complicated pneumonia were due to a VT; predominantly 3, 19A, 19F. Children with risk factors were more likely to present with bacteraemia ± sepsis (42% vs 12%) and to have a non-vaccine serotype (NVT) (74% vs 32%). Resistance to ceftriaxone (meningitis cut-off) occurred in 17% of 23B isolates (n=12) and accounted for 22% (5/23) of meningitis cases.

Conclusions: Complicated pneumonia is the most common IPD presentation. NVTs account for the majority of bacteraemia and meningitis episodes. High rates of ceftriaxone resistance for NVT 23B support the addition of vancomycin for empiric treatment of suspected meningitis.

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澳大利亚儿童侵袭性肺炎球菌疾病流行病学：前瞻性队列研究。

背景：肺炎球菌结合疫苗（PCV）的广泛使用改变了全球儿童侵袭性肺炎球菌疾病（IPD）的流行病学：方法：对澳大利亚五家儿科医院在 2016 年至 2021 年 6 月的 5.5 年间发生的 IPD 病例进行多中心前瞻性审计。纳入儿童（从无菌部位分离出肺炎链球菌）：结果：375 名儿童共发生 377 例 IPD：338人（90%）接受过≥3次PCV治疗；42人（11%）有IPD风险因素。最常见的病症是复杂性肺炎（254 例，占 67%）、菌血症（65 例，占 17%）和脑膜炎（29 例，占 8%）。有 230 例（61%）病例的血清型信息可用；其中 140 例（61%）为 13vPCV 疫苗血清型 (VT)。大多数（85%）的复杂性肺炎是由 VT 引起的，主要是 3、19A 和 19F。有风险因素的患儿更有可能出现菌血症和败血症（42% 对 12%），也更有可能出现非疫苗血清型 (NVT)（74% 对 32%）。对头孢曲松（脑膜炎临界值）产生耐药性的分离株占23B分离株的17%（n=12），占脑膜炎病例的22%（5/23）：结论：并发肺炎是 IPD 最常见的表现形式。结论：并发性肺炎是 IPD 最常见的病症，NVT 占菌血症和脑膜炎病例的大多数。NVT 23B 的头孢曲松耐药率较高，因此在对疑似脑膜炎进行经验性治疗时应添加万古霉素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Archives of Disease in Childhood 医学-小儿科

CiteScore

5.80

自引率

3.80%

发文量

291

审稿时长

3-6 weeks

期刊介绍： Archives of Disease in Childhood is an international peer review journal that aims to keep paediatricians and others up to date with advances in the diagnosis and treatment of childhood diseases as well as advocacy issues such as child protection. It focuses on all aspects of child health and disease from the perinatal period (in the Fetal and Neonatal edition) through to adolescence. ADC includes original research reports, commentaries, reviews of clinical and policy issues, and evidence reports. Areas covered include: community child health, public health, epidemiology, acute paediatrics, advocacy, and ethics.