Changes in the incidence and bacterial aetiology of paediatric parapneumonic pleural effusions/empyema in Germany, 2010–2017: a nationwide surveillance study

Abstract

a b s t r a c tObjectives: Parapneumonic pleural effusions/empyema (PPE/PE) are severe complications of communityacquired pneumonia. We investigated the bacterial aetiology and incidence of paediatric PPE/PE in Germany after the introduction of universal pneumococcal conjugate vaccine (PCV) immunization for infants. Methods: Children <18 years of age hospitalized with pneumonia-associated PPE/PE necessitating pleural drainage or persisting >7 days were reported to the German Surveillance Unit for Rare Diseases in Childhood between October 2010 and June 2017. All bacteria detected in blood or pleural fluid (by culture/PCR) were included, with serotyping for Streptococcus pneumoniae. Results: The median age of all 1447 PPE/PE patients was 5 years (interquartile range 3e10). In 488 of the 1447 children with PPE/PE (34%), 541 bacteria (>40 species) were detected. Aerobic gram-positive cocci accounted for 469 of 541 bacteria detected (87%); these were most frequently Streptococcus pneumoniae (41%), Streptococcus pyogenes (19%) and Staphylococcus aureus (6%). Serotype 3 accounted for 45% of 78 serotyped S. pneumoniae strains. Annual PPE/PE incidence varied between 14 (95%CI 12e16) and 18 (95%CI 16e21) PPE/PE per million children. Incidence of S. pneumoniae PPE/PE decreased from 3.5 (95%CI 2.5e4.6) per million children in 2010/11 to 1.5 (95%CI 0.9e2.4) in 2013/14 (p 0.002), followed by a reincrease to 2.2 (95%CI 1.5e3.2) by 2016/17 (p 0.205). Conclusions: In the era of widespread PCV immunization, cases of paediatric PPE/PE were still caused mainly by S. pneumoniae and, increasingly, by S. pyogenes. The re-increase in the incidence of PPE/PE overall and in S. pneumoniae-associated PPE/PE indicates ongoing changes in the bacterial aetiology and requires further surveillance.

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

“…We retrospectively analyzed the feasibility and outcome following an uniform management algorithm for childhood PPE/PE that included (I) enforced pathogen identification with initial diagnostic pleural tap, (II) 14-day-course of antibiotics, i.e., AMX/AMC or targeted treatment according to microbiological test results, and (III) surgical interventions restricted to cases with respiratory compromise, seropneumothorax, and/or large effusions with mediastinal shift. Using this management algorithm, we corroborate previous findings on the significantly increased percentage of pathogen identification in pleural fluid by extended diagnostic techniques compared to the yield from blood cultures alone [13,24,25,26,27,28,29]. In our study, initial pleural tap increased pathogen detection from 17% detection rate by blood cultures to 78% detection rate by microbiological analyses of pleural fluid of PPE/PE patients.…”

Diversity of Serotype Replacement After Pneumococcal Conjugate Vaccine Implementation in Europe

“…4,15 By contrast, for bacteremic pneumonia and pneumonia with pleural effusion, no increase in cases was reported in France 16 and England, 17 with a small increase in cases of empyema in Germany. 18 These different trends between these clinical entities agree with a recent study comparing the spectrum of IPD over time in the PCV13 era and the specific tropism of VTs and NVTs. 9 The frequency of pneumonia greatly decreased but not that of meningitis or bacteremia without source.…”

Visuomenėje įgytos vaikų pneumonijos komplikacijų diagnostika ir gydymas

“…Įvairių autorių duomenimis, vaikų komplikuotų pneumonijų etiologiją pavyksta nustatyti tik 34-78 proc. atvejų [3,[11][12][13]. Periferinio kraujo mikrobiologiniai pasėliai, serologiniai, bronchų sekreto bei pleuros punktato tyrimai -tai dažniausi tyrimo metodai [3].…”

“…Tais atvejais, kai yra nekrozinė pneumonija, abscesas, empiema ir bronchopulmoninė fistulė, visada reikėtų įtarti ne tik streptokoko, bet ir stafilokoko sukeltą infekciją, ypač gripo koinfekcijos atvejais [2,3,11,15]. Nustačius S. aureus, rekomenduojama patikslinti ne tik bakterijos jautrumą meticilinui, bet ir gebėjimą išskirti Pantono -Valentino leukocidino (PVL) toksiną [16].…”