Clinical characteristics and antimicrobial resistance of pneumococcal isolates of pediatric invasive pneumococcal disease in China

Abstract

PurposeStreptococcus pneumoniae causes serious infections globally, including invasive pneumococcal disease (IPD). We analyze clinical features of pediatric IPD cases identified in China and antibiotic susceptibility of isolated pneumococcal strains.MethodsConfirmed pediatric IPD patients were prospectively recruited to the study. Symptoms at the time of hospitalization, laboratory tests, antimicrobial susceptibility of pneumococcal isolates, treatments, hospital stay, and residual findings at discharge were analyzed systematically.ResultsFrom January 2008 to December 2017, a total of 123 hospitalized children diagnosed with IPD were enrolled: 68 from pediatric departments of Xinhua Hospital, and 55 from Lanzhou University Second Hospital. Of these pediatric IPD patients, 81 (65.86%) were male, and 98 (79.67%) <5 years old. Most cases (96, 78.05%) were diagnosed during the cold season between September and February. Sepsis was observed in 82 (66.67%) patients, 48 (39.02%) children were diagnosed with meningitis, 41 (33.33%) with pneumonia, 30 (24.39%) with pleurisy, and 4 (3.25%) with osteomyelitis. Underlying diseases were noted in 35 (28.45%) patients and concurrent infections in 45 (36.58%). The overall mortality rate was 2.44%. IPD children who developed sepsis and necrotizing pneumonia showed higher proportions of intensive care-unit admission, intravenous γ-globulin, glucocorticoid use, hemofiltration and ventilator, and longer duration of fever, hospital stay, and antibiotic use than nonsepsis and pneumonia subjects. Antimicrobial resistance of S. pneumoniae showed a highly unsusceptible rate for erythromycin (96.75%), trimethoprim-sulfamethoxazole (79.67%), and tetracycline (77.23%). All isolates were sensitive to vancomycin, linezolid, and levofloxacin.ConclusionClinical symptoms were severe in the majority of pediatric IPD patients. More intensive treatments were demanded for IPD children with sepsis and necrotizing pneumonia. High resistance rates for erythromycin, trimethoprim–sulfamethoxazole, and tetracycline were found.

Epidemiology Characteristics of Streptococcus pneumoniae From Children With Pneumonia in Shanghai: A Retrospective Study

“…In this study, we identified a total of 287 pediatric patients diagnosed with pneumococcal pneumonia from January to December 2018 in Shanghai, China. Most of them (261,90.9%) were under 5 years old and diagnosed less in the summer, which was in line with the recent results from China (Cai et al, 2018). A male sexual superiority was also noticed among the study population, so as in other studies (Cai et al, 2018; Arushothy et al, 2019).…”

“…Most of them (261,90.9%) were under 5 years old and diagnosed less in the summer, which was in line with the recent results from China (Cai et al, 2018). A male sexual superiority was also noticed among the study population, so as in other studies (Cai et al, 2018; Arushothy et al, 2019). In current study, chronic diseases were observed in 15.7% patients, which is an independent risk factor for pneumonia-related mortality in children (Zhang et al, 2013; Sonego et al, 2015; Nguyen et al, 2017).…”

Serotype distribution and antimicrobial resistance patterns of invasive pneumococcal disease isolates from children in mainland China—a systematic review

“…In the Asian Network for Surveillance of Resistant Pathogens (ANSORP) report [49], following the revised CLSI breakpoints, the prevalence of penicillin resistance for nonmmeningitis strains was 0.7% and for meningitis isolates was 57.7%. In the included twelve articles [17,[24][25][26][27][28][29][30][31][32][33][34], only four separately reported penicillin resistance rates of meningitis and nonmmeningitis isolates [17,[24][25][26] and the data were consistent with the results from ANSORP [49]. Actually, it is important for researchers and clinical workers to distinguish specimen types and resistance patterns for meningitis and nonmmeningitis isolates.…”

“…We screened 42 articles in our preliminary search, of which 16 studies [17,[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] fulfilled inclusion criteria and were included in the final analysis ( Fig. 1).…”

“…1). Among them, 4 studies only focused on only serotypes [20][21][22][23], 6 reported only antibiotic resistance patterns [29][30][31][32][33][34], and the other 6 recorded both serotypes and antibiotic resistance profiles [17,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38]. Of these, 7 articles [17,20,[24][25][26][27]29] were published in English, and 10 [21-23, 28, 30-34] were reported in Chinese language journals.…”