Clinical features and outcomes of invasive pneumococcal disease in a pediatric intensive care unit

BACKGROUND Invasive pneumococcal disease (IPD) results in high morbidity and mortality globally each year, although it is a vaccine-preventable disease. This study aimed to characterize the clinical features of IPD in a pediatric intensive care unit (PICU) in Taiwan. The seven-valent pneumococcal conjugate vaccine (PCV7) was introduced in the private sector in October 2005. The estimated coverage rate of PCV7 vaccination in 2010 was 45.5% among children <5 years of age. METHODS We conducted a retrospective study at a single center in northern Taiwan for invasive pneumococcal disease in a PICU from 2009 to 2013. Demographic characteristics, clinical courses, serotype, antibiotic susceptibility, and outcomes were analyzed. RESULTS Over the 5-year study period, 2167 patients were admitted to the PICU; 48 (2.2%) had IPD. There were 29 female and 19 male patients. Their mean age was 3.7 years (range 0.7-12.5 years, with the peak age at 2-5 years; n = 30, 63%). Pneumonia was the most frequent type (n = 38, 79%), followed by meningitis (n = 10, 21%). In total, three patients died, all within 72 h after admission; the final diagnoses were all meningitis. Thirty-four children with pneumonia received chest tube insertion for pleural effusion drainage. Of them, 22 (65%) finally still underwent video-assisted thoracoscopic surgery. Eight (17%) children had hemolytic uremic syndrome, and seven of them underwent hemodialysis. In total, 37 serotypes were detected; 95% were covered by PCV13. Serotype 19A was most common (54%) overall; however, in those with meningitis, serotype 19 F was most common. CONCLUSIONS Meningitis is the most severe type of invasive pneumococcal disease in our pediatric intensive care unit. It may progress rapidly even when subjects are given antibiotics promptly. The most common serotype in meningitis is 19 F, which is vaccine preventable. Thus, universal mass pneumococcal vaccination is still needed.