Change in Bacterial Causes of Community-Acquired Parapneumonic Effusion and Pleural Empyema in Children 6 Years After 13-Valent Pneumococcal Conjugate Vaccine Implementation

Madhi, Fouad; Lévy, Corinne; Morin, Laurence; Minodier, Philippe; Dubos, François; Zenkhri, Férielle; Dommergues, Marie Aliette; Mezgueldi, Ellia; Levieux, Karine; Béchet, Stéphane; Varon, Emmanuelle; Cohen, Robert; Gpip,

doi:10.1093/jpids/piy103

Cited by 38 publications

(35 citation statements)

References 12 publications

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“…S. pneumoniae was the most frequently identified pathogen, followed by S. pyogenes and S. aureus , which is in agreement with previously published data on the etiology of PPE/PE in children worldwide [26,28,31,32,33,34,35,36]. The study period covered the introduction of PCVs in Switzerland among all children <2 years of age (with a catch-up dose up to five years of age) with PCV7 in 2006 and a switch to PCV13 in 2011 [17].…”

Section: Discussionsupporting

confidence: 91%

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Pleural Tap-Guided Antimicrobial Treatment for Pneumonia with Parapneumonic Effusion or Pleural Empyema in Children: A Single-Center Cohort Study

Sauteur

Burkhard

Moehrlen

et al. 2019

JCM

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Parapneumonic effusion or pleural empyema (PPE/PE) is a frequent complication of community-acquired pneumonia (CAP) in children. Different management approaches exist for this condition. We evaluated a 14-day treatment with amoxicillin (AMX) with/without clavulanic acid (AMC) confirmed or modified by microbiological findings from pleural tap. Children ≤16 years of age with radiologically diagnosed PPE/PE and initial diagnostic pleural tap were included at University Children’s Hospital Zurich from 2001–2015. AMX/AMC was given for 14 days and rationalized according to microbiological pleural tap results. Clinical and radiological follow-up was scheduled until six months or full recovery. In 114 of 147 (78%) children with PPE/PE a pathogen was identified by culture, polymerase chain reaction (PCR), and/or antigen testing. Streptococcus pneumoniae was detected in 90 (79%), S. pyogenes in 13 (11%), and Staphylococcus aureus in seven cases (6%), all but two cultured pathogens (96%) were sensitive to AMX/AMC. One-hundred two of 147 (69%) patients received treatment with AMX/AMC for 14 days. They recovered more rapidly than patients with a different management (p = 0.026). Of 139 children with follow-up, 134 (96%) patients fully recovered. In conclusion, 14-day AMX/AMC treatment confirmed and rarely modified by microbiological findings from pleural tap resulted in full recovery in >95% of children with PPE/PE.

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Section: Discussionsupporting

confidence: 91%

“…Our data confirm that empirical antibiotic treatment must target S. pneumoniae and cover S. pyogenes and S. aureus [11,28,35]. The choice of the empirical antibiotic agent should be guided by local resistance data and the emergence of resistant organisms [11].…”

Section: Discussionsupporting

confidence: 60%

Pleural Tap-Guided Antimicrobial Treatment for Pneumonia with Parapneumonic Effusion or Pleural Empyema in Children: A Single-Center Cohort Study

Sauteur

Burkhard

Moehrlen

et al. 2019

JCM

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“…Almost 60% of children (38/64) developed complications, mainly pleural effusion/empyema (34/64, 53%). Twenty-nine patients [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31], p = 0.015) and had a longer hospital stay (17 [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] days vs. 4.5 [1][2][3][4][5][6][7], p < 0.001).…”

Section: Resultsmentioning

confidence: 98%

“…The introduction of pneumococcal conjugate vaccines (PCV) has led to a substantial reduction of invasive pneumococcal disease and community-acquired pneumococcal pneumonia (9)(10)(11)(12). However, their impact in pediatric CAP caused by other bacteria has been barely analyzed (13,14). The aims of this study were to describe the characteristics of microbiologically confirmed hospitalized bacterial CAP in a setting with high PCV coverage, to compare outcomes according to causative bacteria and to analyze epidemiological changes over time.…”

Section: Introductionmentioning

confidence: 99%

Outcome of Severe Bacterial Pneumonia in the Era of Pneumococcal Vaccination

et al. 2020

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Introduction: After the introduction of pneumococcal conjugate vaccines, community-acquired pneumonia (CAP) caused by Streptococcus pneumoniae has decreased whereas Staphylococcus aureus and Streptococcus pyogenes could be increasing. These bacteria have been associated with high rates of complications.Aims: (1) To describe the characteristics of pediatric bacterial CAP requiring hospitalization. (2) To compare outcomes according to causative microorganisms. (3) To analyze changes in bacterial CAP rate and etiology over time.Patients and Methods: Retrospective single-center study of inpatients aged 1 month-16 years with culture-confirmed bacterial CAP in 2010-2018 in Madrid, Spain.Results: We included 64 cases (42 S. pneumoniae, 13 S. pyogenes and 9 S. aureus). Culture-confirmed CAP represented 1.48-2.33/1,000 all-cause pediatric hospital admissions, and its rate did not vary over time. However, there was a significant decrease in pneumococcal CAP in the last 3 years of the study (78% of CAP in 2010–2015 vs. 48% in 2016-18, p = 0.017). Median hospital stay was 10.5 days (interquartile range 5-19.5), 38 patients (59%) developed complications and 28 (44%) were admitted to the intensive care unit. Outcomes were similar among children with S. pneumoniae and S. aureus CAP, whereas S. pyogenes was associated with a higher risk for complications (OR 8 [95%CI 1.1-57.2]) and ICU admission (OR 7.1 [95%CI 1.7-29.1]) compared with pneumococcal CAP.Conclusion: In a setting with high PCV coverage, culture-confirmed bacterial CAP did not decrease over time and there was a relative increase of S. pyogenes and S. aureus. Children with CAP caused by S. pyogenes were more likely to develop complications.

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“…The effectiveness and impact of the 13-valent pneumococcal conjugate vaccine (PCV13) against serotype 3 Streptococcus pneumoniae (ser3) has been repeatedly questioned [1][2][3][4][5]. Ser3 pneumococcus has established itself as one of the leading causes of invasive pneumococcal disease (IPD), even in the post-PCV13 introduction period (post-PCV13) [6], and has been associated with complicated and severe infections in children [5,[7][8][9]. This aggressive behavior can be firstly attributed to microbiological features of the pathogen-like thick polysaccharide capsule [10].…”

Section: Introductionmentioning

confidence: 99%

Impact of the 13-Valent Pneumococcal Conjugate Vaccine on Severe Invasive Disease Caused by Serotype 3 Streptococcus Pneumoniae in Italian Children

et al. 2019

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The effectiveness and impact of the 13-valent pneumococcal conjugate vaccine (PCV13) against invasive pneumococcal diseases (IPD) due to serotype 3 (ser3) has been questioned. However, the impact of PCV13 on different clinical presentations of ser3-IPD has not been studied so far. The impact of PCV13 on different clinical presentations of ser3-IPD in a population of Italian children aged 0–8 years was evaluated, comparing pre- and post-PCV13 introduction period. Real-time polymerase chain reaction (PCR) was used for the diagnosis and serotyping of IPD. During the observation period (1 January 2006–1 August 2018), ser3 was detected in 60/284 (21.1%) children under 8 with serotyped IPD. The incidence of sepsis and meningitis was 0.24 per 1,000,000 person-years (p-y) in pre-PCV13 and 0.02 per 1,000,000 p-y in post-PCV13. No cases occurred in vaccinated children. In the post-PCV13 period, case reduction was 13% for all ser3 IPD and 92% for sepsis and meningitis. Vaccination impact may be underestimated due to significant improvement in pneumococcal surveillance in post-PCVC13. Our data suggest a significant impact of PCV13 on meningitis and sepsis due to ser3 and a lower impact against pneumonia. While waiting for increasingly effective anti-pneumococcal vaccines, PCV13, which guarantees protection against the most severe clinical presentations of ser3-IPD, is currently the most effective prevention option available.

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Change in Bacterial Causes of Community-Acquired Parapneumonic Effusion and Pleural Empyema in Children 6 Years After 13-Valent Pneumococcal Conjugate Vaccine Implementation

Cited by 38 publications

References 12 publications

Pleural Tap-Guided Antimicrobial Treatment for Pneumonia with Parapneumonic Effusion or Pleural Empyema in Children: A Single-Center Cohort Study

Pleural Tap-Guided Antimicrobial Treatment for Pneumonia with Parapneumonic Effusion or Pleural Empyema in Children: A Single-Center Cohort Study

Outcome of Severe Bacterial Pneumonia in the Era of Pneumococcal Vaccination

Impact of the 13-Valent Pneumococcal Conjugate Vaccine on Severe Invasive Disease Caused by Serotype 3 Streptococcus Pneumoniae in Italian Children

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