51
|
Kendall BA, Dascomb KK, Mehta RR, Stockmann C, Mason EO, Ampofo K, Pavia AT, Byington CL. Early Streptococcus pneumoniae serotype changes in Utah adults after the introduction of PCV13 in children. Vaccine 2015; 34:474-478. [PMID: 26706276 DOI: 10.1016/j.vaccine.2015.12.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 11/14/2015] [Accepted: 12/02/2015] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Pneumococcal conjugate vaccines (PCV) have indirect effects due to decreased Streptococcus pneumoniae colonization in vaccine recipients. We sought to determine whether the introduction of PCV13 in children led to changes in the epidemiology and clinical manifestations of invasive pneumococcal disease (IPD) in adults. METHODS We described demographics, comorbidities, clinical manifestations, and serotypes of IPD in Utah adults before (November 2009-February 2010) and after (March 2010-March 2012) the introduction of PCV13 in children. We also compare serotypes causing IPD in Utah adults and children. RESULTS After the introduction of PCV13 in the childhood vaccine program, the proportion of IPD due to PCV13 exclusive serotypes decreased significantly in Utah adults (64-40%, p=0.009), primarily due to a decline in serotype 7F (36-15%, p=0.008). There were non-significant increases in IPD due to Pneumococcal polysaccharide 23 (PPV23) unique serotypes and non-vaccine serotypes, most notably serotype 22F. Changes in the proportions of vaccine and non-vaccine serotypes were similar in adults and children. Meningitis was more commonly due to non-vaccine serotypes relative to non-meningitis cases (47% vs. 18%, p=0.007). When stratified by sex, decreases in PCV13 serotype IPD were only noted in men (76-33%, p=0.001). CONCLUSIONS Serotype epidemiology of IPD in adults closely follows that of children in the PCV13 era. Continued surveillance is needed to confirm whether replacement serotypes will lead to increases in pneumococcal meningitis and whether there are sex differences in the indirect effects of PCV vaccination in children.
Collapse
Affiliation(s)
- Brian A Kendall
- Departments of Medicine and Pathology, University of Utah, Salt Lake City, UT, USA.
| | - Kristin K Dascomb
- Departments of Medicine and Pathology, University of Utah, Salt Lake City, UT, USA; Department of Infectious Diseases, Intermountain Healthcare, Murray, UT, USA
| | - Rajesh R Mehta
- Department of Infectious Diseases, Intermountain Healthcare, Murray, UT, USA
| | - Chris Stockmann
- Department of pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Edward O Mason
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Krow Ampofo
- Department of pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Andrew T Pavia
- Department of pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Carrie L Byington
- Department of pediatrics, University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
52
|
Abstract
BACKGROUND South Africa introduced the 7-valent pneumococcal conjugate vaccine (PCV7) in 2009 and PCV13 in 2011. The etiology and incidence of childhood empyema in an 8-year period overlapping the introduction of PCV was investigated. METHODS Children younger than 12 years admitted with empyema at a tertiary pediatric hospital in Cape Town, South Africa, from December 2006 to December 2011 (cohort A) and January 2012 to December 2014 (cohort B) were investigated. Pathogens were identified by culture of pleural fluid and blood. In addition, polymerase chain reaction targeting bacterial pathogens and Streptococcus pneumoniae serotypes was conducted on pleural fluid in a subset of patients enrolled 2009-2011. RESULTS Cohort A: 142 children were prospectively enrolled, with a median age of 17 months (interquartile range 8-43). Most (92%) children were unimmunized with PCV. S. pneumoniae and Staphylococcus aureus were the most common culture-identified pathogens (each 25 of 142; 18%); polymerase chain reaction of pleural fluid increased yield of S. pneumoniae detection by 31% [26 of 54 (48%) vs. 9 of 54 (17%), P < 0.001]. Serotypes were identified for 24 of 26 (92%) patients with S. pneumoniae, of which 22 of 24 (92%) were included in PCV13. Cohort B: 22 patients were retrospectively identified. No pathogen was found in 12 of 22 (54.5%) patients and S. pneumoniae in 1 patient (4.5%). Empyema incidence declined by 50% in cohort B compared with that of cohort A (4.2 vs. 10.4 cases per 1000 pneumonia admissions; risk ratio: 0.5; 95% confidence incidence: 0.3-0.7). CONCLUSION S. pneumoniae is the commonest cause of childhood empyema in South Africa. PCV has been highly effective at reducing empyema incidence in South African children.
Collapse
|
53
|
Lagousi T, Papadatou I, Kopsidas I, Critselis E, Theodoridou M, Spoulou V. Epidemiology of Community-Acquired Pneumonia Hospitalizations and Associated Complications Before and After the Implementation of the Heptavalent Pneumococcal Conjugate Vaccine in Athens, Greece. J Pediatric Infect Dis Soc 2015; 4:260-3. [PMID: 26407430 DOI: 10.1093/jpids/pit088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 11/20/2013] [Indexed: 11/14/2022]
Abstract
We determined the rates of community-acquired pneumonia (CAP)-associated hospitalizations and complications in Athens, over a period covering 4 years before and 4 years after the implementation of the 7-valent pneumococcal vaccine (PCV7) in Greece. PCV7 had no impact on pediatric CAP rates, whereas there was an increase in CAP-associated complications.
Collapse
Affiliation(s)
- Theano Lagousi
- First University Department of Pediatrics, "Aghia Sophia" Children's Hospital, National and Kapodistrian University of Athens School of Medicine, Greece
| | - Ioanna Papadatou
- First University Department of Pediatrics, "Aghia Sophia" Children's Hospital, National and Kapodistrian University of Athens School of Medicine, Greece
| | - Ioannis Kopsidas
- First University Department of Pediatrics, "Aghia Sophia" Children's Hospital, National and Kapodistrian University of Athens School of Medicine, Greece
| | - Elena Critselis
- The Stavros Niarchos Foundation-Collaborative Center for Clinical Epidemiology and Outcomes Research, First and Second University Departments of Pediatrics, National and Kapodistrian University of Athens School of Medicine, Greece
| | - Maria Theodoridou
- First University Department of Pediatrics, "Aghia Sophia" Children's Hospital, National and Kapodistrian University of Athens School of Medicine, Greece
| | - Vana Spoulou
- First University Department of Pediatrics, "Aghia Sophia" Children's Hospital, National and Kapodistrian University of Athens School of Medicine, Greece
| |
Collapse
|
54
|
Abstract
OBJECTIVES To determine predictors for surgical intervention of thoracic empyema in children, and its associated morbidity. METHODS We conducted a retrospective review of medical records of children with empyema thoracis admitted in the Maternity and Children Hospital, Al Madinah Al Munawwarah, Saudi Arabia between January 2007 and January 2012. The data extracted included: socio-demographic data, clinical data, method of treatment, and follow up data. According to the introduced therapeutic methods, a total of 62 patients were divided into 2 groups; patients treated with chest tube (CT) insertion (51 cases), and 11 cases that required thoracotomy (TH); groups were compared to determine predictors for thoracotomy. RESULTS Of 62 patients, 37 were females and 25 were males. In terms of age, side of lesion, presence of cough, or dyspnea, both groups were homogenous. Both groups had significant differences for duration of complaint (TH and CT) (13.5±6.5 days versus 10±3.6, p=0.005), presence of fever (90.2% versus 36.4%, p less than 0.001), history of recurrent chest infections (90.9% versus 37.3%, p=0.001), and radiological findings. However, it was not evident that any of these variables influenced treatment decision except absence of fever, which was significantly less in patients treated with thoracotomy. CONCLUSION No specific indicator was found to increase expectancy for surgical intervention as a treatment choice, except the absence of fever, which may reflect the delayed referral and prolonged use of antibiotics and cannot be interpreted truly without caution as an indicator for surgical intervention.
Collapse
Affiliation(s)
- Hamdi H Almaramhy
- Surgery Department, Faculty of Medicine, Taibah University, Al Madinah Al Munawwarah, Kingdom of Saudi Arabia. E-mail.
| | | |
Collapse
|
55
|
Taylor JL, Liu M, Hoff DS. Retrospective analysis of large-dose intrapleural alteplase for complicated pediatric parapneumonic effusion and empyema. J Pediatr Pharmacol Ther 2015; 20:128-37. [PMID: 25964730 DOI: 10.5863/1551-6776-20.2.128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Medical treatment of complicated parapneumonic effusion or empyema in pediatric patients includes antibiotics and pleural space drainage. Intrapleural fibrinolysis may facilitate pleural drainage; however, there is a lack of consensus regarding the optimal dosing regimen. The primary purpose of this study was to evaluate the efficacy and safety of a large-dose intrapleural alteplase regimen in pediatric patients. Secondarily, this investigation sought to differentiate the clinical characteristics of responders and non-responders to intrapleural alteplase therapy. METHODS All patients with parapneumonic effusions treated with intrapleural alteplase between June 2003 and December 2011 were reviewed retrospectively. Efficacy was assessed by comparing chest tube output, in mL/hr and mL/kg/hr, for 24 hours before and after the first dose of alteplase. Additional efficacy outcomes included duration of in situ chest tubes, a need for surgical intervention for pleural effusion, and length of hospital stay. Safety was assessed by frequency and severity of adverse events. Non-responders and responders were compared based on demographic and disease characteristics. Responders were defined as patients who did not require surgical intervention after intrapleural alteplase therapy. RESULTS Seventy-three patients, aged 0.5 to 22.5 years, received intrapleural alteplase to facilitate pleural drainage. Median alteplase dose was 7 mg (range, 3 to 10 mg; median 0.38 mg/kg). Chest tube output increased from 10.7 to 24.2 mL/hr (p = 0.006), and median length of hospital stay was 9 days. Eighty-four percent of patients were responders. The most common adverse events were pain (20.5%) and oxygen desaturation greater than 10% from baseline (16.4%). High-flow nasal cannula was the most common intervention for oxygen desaturation to 80% to 90%. Nine patients (12%) required a blood transfusion during the study. CONCLUSION Large-dose intrapleural alteplase is effective in facilitating pleural drainage in pediatric patients with complicated parapneumonic effusion or empyema. Common adverse effects include pain and oxygen desaturation. The potential for bleeding warrants clinical monitoring.
Collapse
Affiliation(s)
- Jessica L Taylor
- Department of Pharmacy, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota
| | - Meixia Liu
- Department of Healthcare Economics, Medica, Hopkins, Minnesota
| | - David S Hoff
- Department of Pharmacy, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota
| |
Collapse
|
56
|
Ferreiro L, San José ME, Valdés L. Management of Parapneumonic Pleural Effusion in Adults. Arch Bronconeumol 2015; 51:637-46. [PMID: 25820035 DOI: 10.1016/j.arbres.2015.01.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 01/15/2015] [Accepted: 01/16/2015] [Indexed: 11/30/2022]
Abstract
Pleural infections have high morbidity and mortality, and their incidence in all age groups is growing worldwide. Not all infectious effusions are parapneumonic and, in such cases, the organisms found in the pleural space are not the same as those observed in lung parenchyma infections. The diagnostic difficulty lies in knowing whether an infectious effusion will evolve into a complicated effusion/empyema, as the diagnostic methods used for this purpose provide poor results. The mainstays of treatment are to establish an early diagnosis and to commence an antibiotic regimen and chest drain as soon as possible. This should preferably be carried out with fine tubes, due to certain morphological, bacteriological and biochemical characteristics of the pleural fluid. Fluid analysis, particularly pH, is the most reliable method for assessing evolution. In a subgroup of patients, fibrinolytics may help to improve recovery, and their combination with DNase has been found to obtain better results. If medical treatment fails and surgery is required, video-assisted thoracoscopic surgery (VATS) is, at least, comparable to decortication by thoracotomy, so should only undertaken if previous techniques have failed. Further clinical trials are needed to analyze factors that could affect the results obtained, in order to define new evidence-based diagnostic and therapeutic strategies that provide more effective, standardized management of this disease.
Collapse
Affiliation(s)
- Lucía Ferreiro
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, La Coruña, España
| | - María Esther San José
- Servicio de Análisis Clínicos, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, La Coruña, España; Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, La Coruña, España
| | - Luis Valdés
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, La Coruña, España; Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, La Coruña, España.
| |
Collapse
|
57
|
Nath S, Thomas M, Spencer D, Turner S. Has the incidence of empyema in Scottish children continued to increase beyond 2005? Arch Dis Child 2015; 100:255-8. [PMID: 25260518 DOI: 10.1136/archdischild-2014-306525] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The incidence of empyema increased dramatically in children during the 1990s and early 2000s. We investigated the relationship between changes in the incidence of childhood empyema in Scotland following the 2006 introduction of routine heptavalent conjugate pneumococcal vaccination (PCv-7) and the 2010 introduction of the 13-valent (PCV-13) vaccine. METHODS This was a whole-population study of Scottish hospital admissions between 1981 and 2013 using ICD (International Classification of Diseases)-9 and ICD-10 diagnostic codes for empyema. The number of admissions for pneumonia and croup was also captured to give insight into secular trends in admissions with other related and unrelated respiratory presentations. RESULTS There were 217 admissions with empyema between 1981 and 2005 (mean incidence 9 cases/million/year) and 323 between 2006 and 2013 (mean incidence 47 cases/million/year), p<0.001. The introduction of conjugate vaccines in 2006 was associated with an overall increase in admissions for empyema of 2.0 (95% CI 1.4 to 2.8) per 100 000 children, however, the incidence rate ratio for empyema admission between 2010 and 2013 was lower relative to 2006-2009 (0.78 (95% CI 0.63 to 0.98)). Secular changes in pneumonia, but not croup, were comparable with those for empyema. CONCLUSIONS The incidence of empyema in Scottish children initially rose in children aged 1 to 9 years after the introduction of routine conjugate pneumococcal vaccination, however, empyema incidence has fallen since 2010 when the PCV-13 was introduced.
Collapse
Affiliation(s)
- Stuart Nath
- Department of Child Health, University of Aberdeen, Aberdeen, UK
| | - Matt Thomas
- Department of Respiratory Paediatrics, Newcastle-upon-Tyne Hospitals NHS Trust, Newcastle-upon-Tyne, UK Institute for Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK
| | - David Spencer
- Department of Respiratory Paediatrics, Newcastle-upon-Tyne Hospitals NHS Trust, Newcastle-upon-Tyne, UK
| | - Steve Turner
- Department of Child Health, University of Aberdeen, Aberdeen, UK
| |
Collapse
|
58
|
Myr RK, Bere E, Øverby NC. Test-retest reliability of a new questionnaire on the diet and eating behavior of one year old children. BMC Res Notes 2015; 8:16. [PMID: 25616767 PMCID: PMC4320631 DOI: 10.1186/s13104-014-0966-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 12/30/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As part of a sub-study in the ongoing Norwegian RCT 'Fit for Delivery', a new questionnaire, using a combination of food frequency, scale, and categorical questions to gather data on the diets and eating patterns of one year olds, was developed and tested for reliability by test-retest. RESULTS Of 102 parents recruited to the study, 94 completed both test and retest. Correlation coefficients (Spearman's r, and/or Cohen's kappa, where applicable) were high for all categories of question, with a mean value of 0.72 for Spearman's r for food frequency variables, and a mean value of 0.75 for Cohen's kappa for non-numeric variables such as breast feeding status, showing very high test-retest reliability. CONCLUSIONS This newly developed diet and eating habit questionnaire had strong test-retest reliability in a test population similar to the study population, for which it was developed. This indicates that the questionnaire is reliable in this population.
Collapse
Affiliation(s)
- Rachel Kristin Myr
- Department of Public Health, Sports and Nutrition, University of Agder, Serviceboks 422, 4604, Kristiansand, Norway.
| | - Elling Bere
- Department of Public Health, Sports and Nutrition, University of Agder, Serviceboks 422, 4604, Kristiansand, Norway.
| | - Nina Cecilie Øverby
- Department of Public Health, Sports and Nutrition, University of Agder, Serviceboks 422, 4604, Kristiansand, Norway.
| |
Collapse
|
59
|
Stillion JR, Letendre JA. A clinical review of the pathophysiology, diagnosis, and treatment of pyothorax in dogs and cats. J Vet Emerg Crit Care (San Antonio) 2015; 25:113-29. [PMID: 25582193 DOI: 10.1111/vec.12274] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 09/15/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To review the current literature in reference to the pathophysiology, diagnosis, and treatment of pyothorax in dogs and cats. ETIOLOGY Pyothorax, also known as thoracic empyema, is characterized by the accumulation of septic purulent fluid within the pleural space. While the actual route of pleural infection often remains unknown, the oral cavity and upper respiratory tract appear to be the most common source of microorganisms causing pyothorax in dogs and cats. In human medicine, pyothorax is a common clinical entity associated with bacterial pneumonia and progressive parapneumonic effusion. DIAGNOSIS Thoracic imaging can be used to support a diagnosis of pleural effusion, but cytologic examination or bacterial culture of pleural fluid are necessary for a definitive diagnosis of pyothorax. THERAPY The approach to treatment for pyothorax varies greatly in both human and veterinary medicine and remains controversial. Treatment of pyothorax has classically been divided into medical or surgical therapy and may include administration of antimicrobials, intermittent or continuous thoracic drainage, thoracic lavage, intrapleural fibrinolytic therapy, video-assisted thoracic surgery, and traditional thoracostomy. Despite all of the available options, the optimal treatment to ensure successful short- and long-term outcome, including the avoidance of recurrence, remains unknown. PROGNOSIS The prognosis for canine and feline pyothorax is variable but can be good with appropriate treatment. A review of the current veterinary literature revealed an overall reported survival rate of 83% in dogs and 62% in cats. As the clinical presentation of pyothorax in small animals is often delayed and nonspecific, rapid diagnosis and treatment are required to ensure successful outcome.
Collapse
Affiliation(s)
- Jenefer R Stillion
- Western Veterinary Specialist and Emergency Centre, Calgary, Alberta, Canada
| | | |
Collapse
|
60
|
Acute Pneumonia. MANDELL, DOUGLAS, AND BENNETT'S PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES 2015. [PMCID: PMC7151914 DOI: 10.1016/b978-1-4557-4801-3.00069-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
61
|
Lindstrand A, Bennet R, Galanis I, Blennow M, Ask LS, Dennison SH, Rinder MR, Eriksson M, Henriques-Normark B, Ortqvist A, Alfvén T. Sinusitis and pneumonia hospitalization after introduction of pneumococcal conjugate vaccine. Pediatrics 2014; 134:e1528-36. [PMID: 25384486 DOI: 10.1542/peds.2013-4177] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Streptococcus pneumoniae is a major cause of pneumonia and sinusitis. Pneumonia kills >1 million children annually, and sinusitis is a potentially serious pediatric disease that increases the risk of orbital and intracranial complications. Although pneumococcal conjugate vaccine (PCV) is effective against invasive pneumococcal disease, its effectiveness against pneumonia is less consistent, and its effect on sinusitis is not known. We compared hospitalization rates due to sinusitis, pneumonia, and empyema before and after sequential introduction of PCV7 and PCV13. METHOD All children 0 to <18 years old hospitalized for sinusitis, pneumonia, or empyema in Stockholm County, Sweden, from 2003 to 2012 were included in a population-based study of hospital registry data on hospitalizations due to sinusitis, pneumonia, or empyema. Trend analysis, incidence rates, and rate ratios (RRs) were calculated comparing July 2003 to June 2007 with July 2008 to June 2012, excluding the year of PCV7 introduction. RESULTS Hospitalizations for sinusitis decreased significantly in children aged 0 to <2 years, from 70 to 24 cases per 100 000 population (RR = 0.34, P < .001). Hospitalizations for pneumonia decreased significantly in children aged 0 to <2 years, from 450 to 366 per 100 000 population (RR = 0.81, P < .001) and in those aged 2 to <5 years from 250 to 212 per 100 000 population (RR = 0.85, P = .002). Hospitalization for empyema increased nonsignificantly. Trend analyses showed increasing hospitalization for pneumonia in children 0 to <2 years before intervention and confirmed a decrease in hospitalizations for sinusitis and pneumonia in children aged 0 to <5 years after intervention. CONCLUSIONS PCV7 and PCV13 vaccination led to a 66% lower risk of hospitalization for sinusitis and 19% lower risk of hospitalization for pneumonia in children aged 0 to <2 years, in a comparison of 4 years before and 4 years after vaccine introduction.
Collapse
Affiliation(s)
- Ann Lindstrand
- Public Health Agency of Sweden, Solna, Sweden; Departments of Public Health Sciences, Division of Global Health,
| | | | | | - Margareta Blennow
- Sachs' Children and Youth Hospital, South General Hospital, Stockholm, Sweden; Clinical Sciences and Education, and
| | - Lina Schollin Ask
- Sachs' Children and Youth Hospital, South General Hospital, Stockholm, Sweden
| | | | - Malin Ryd Rinder
- Sachs' Children and Youth Hospital, South General Hospital, Stockholm, Sweden
| | | | - Birgitta Henriques-Normark
- Public Health Agency of Sweden, Solna, Sweden; Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden; Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska University Hospital, Solna, Sweden
| | - Ake Ortqvist
- Department of Communicable Disease Control and Prevention, Stockholm County Council, Sweden; and Department of Medicine, Unit of Infectious Diseases, Karolinska Institutet, Karolinska, Solna, Sweden
| | - Tobias Alfvén
- Departments of Public Health Sciences, Division of Global Health, Sachs' Children and Youth Hospital, South General Hospital, Stockholm, Sweden
| |
Collapse
|
62
|
Real-time polymerase chain reaction for microbiological diagnosis of parapneumonic effusions in Canadian children. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2014; 25:151-4. [PMID: 25285111 PMCID: PMC4173977 DOI: 10.1155/2014/757963] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Community-acquired pneumonia with parapneumonic effusion/empyema is not uncommon in children and can cause serious illness; there -fore, the timely optimization of antimicrobial therapy is essential in this situation. The aim of this study was to determine whether using real-time polymerase chain reaction of pleural fluids to identify the causative organism improves the process of microbiological diagnosis in the context of community-acquired pneumonia with parapneumonic effusion/empyema. This technique was compared with traditional culture methods for microbiological diagnosis. BACKGROUND: Community-acquired pneumonia (CAP) complicated by parapneumonic effusion/empyema is an infectious syndrome commonly encountered by physicians caring for children in Canada. OBJECTIVE: To investigate the incremental benefit of novel molecular testing for the microbiological diagnosis of pediatric CAP complicated by parapneumonic effusion/empyema in Canada. METHODS: A convenience sample of pleural fluid from 56 children who had been admitted to hospital in Ontario with CAP complicated by parapneumonic effusion between 2009 and 2011 was examined. Multiple uniplex real-time polymerase chain reaction (PCR) testing was performed on these pleural fluids and compared with traditional culture-based testing of blood and pleural fluid samples. RESULTS: Molecular methods detected a pathogen in 82% of cases, whereas traditional cultures of blood and pleural fluids detected a pathogen in only 25%. The majority of parapneumonic effusions were associated with pneumococcal infection; Streptococcus pneumoniae was detected in 62% of the samples using molecular methods but in only 14% of samples using culture-based methods. Streptococcus pyogenes, detected in 16% of samples using PCR, was the second most common pathogen found. No patients were found to have empyema caused by Staphylococcus aureus. DISCUSSION: The results showed that multiple uniplex real-time PCR performed substantially better than traditional culture methods for microbiological diagnosis of CAP complicated by effusion/ empyema. S pneumoniae and S pyogenes were found to be responsible for the majority of infections. The approach detected pathogens in a similar proportion of pleural fluid samples as previously reported nested PCR assays; furthermore, the real-time closed-well approach also minimized the risk of nonspecificity due to cross-contamination relative to nested PCR. CONCLUSIONS: Real-time PCR for the detection of bacterial DNA in pleural fluids has the potential to better define the microbiological cause of pediatric CAP. This approach could help clinicians provide targeted antimicrobial therapy.
Collapse
|
63
|
Le Mée A, Mordacq C, Lagrée M, Deschildre A, Martinot A, Dubos F. Survey of hospital procedures for parapneumonic effusion in children highlights need for standardised management. Acta Paediatr 2014; 103:e393-8. [PMID: 24862230 DOI: 10.1111/apa.12702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 04/30/2014] [Accepted: 05/20/2014] [Indexed: 11/26/2022]
Abstract
AIM This study sought to evaluate the initial management of children with parapneumonic effusion admitted to all French university hospitals. METHODS A nationwide survey of all 35 university hospitals took place in 2011 to assess practices for children with parapneumonic effusion, using a hypothetical clinical vignette and a standardised questionnaire. Two to four paediatricians per hospital were interviewed and asked about their initial management, probabilistic antibiotic therapy and its adaptation to microbiological results and subsequent course. Answers from paediatricians working in emergency departments, intensive care units and conventional paediatric units were compared. RESULTS Of the 100 paediatricians contacted, 95 responded. Of these, 98% would order an initial blood test, 70% would order diagnostic thoracentesis, and all would start immediate antibiotic therapy: 31% with a single drug, 67% with two drugs and 2% with three drugs. The most frequent initial choices were third-generation cephalosporin alone (17%) or combined with rifampicin (34%) or vancomycin (24%). Adaptation varied according to drug used, dose and duration, especially when the microorganism was not Streptococcus pneumoniae. Practices did not differ significantly among the different groups of paediatricians. CONCLUSION Standardised management of parapneumonic effusion, including routine thoracentesis and more consistent prescription of antibiotics, is needed.
Collapse
Affiliation(s)
- A Le Mée
- Pediatric Pulmonology Unit; Jeanne de Flandre Hospital; CHRU Lille; Lille France
| | - C Mordacq
- Pediatric Pulmonology Unit; Jeanne de Flandre Hospital; CHRU Lille; Lille France
| | - M Lagrée
- Pediatric Emergency Unit & Infectious Diseases; R. Salengro Hospital; CHRU Lille; UDSL, Lille-2 Nord-de-France University; Lille France
| | - A Deschildre
- Pediatric Pulmonology Unit; Jeanne de Flandre Hospital; CHRU Lille; Lille France
| | - A Martinot
- Pediatric Emergency Unit & Infectious Diseases; R. Salengro Hospital; CHRU Lille; UDSL, Lille-2 Nord-de-France University; Lille France
- EA2694, Public Health: Epidemiology & Quality of Care; UDSL, Lille-2 Nord-de-France University; Lille France
| | - F Dubos
- Pediatric Emergency Unit & Infectious Diseases; R. Salengro Hospital; CHRU Lille; UDSL, Lille-2 Nord-de-France University; Lille France
- EA2694, Public Health: Epidemiology & Quality of Care; UDSL, Lille-2 Nord-de-France University; Lille France
| |
Collapse
|
64
|
Slinger R, Hyde L, Moldovan I, Chan F, Pernica JM. Direct Streptococcus pneumoniae real-time PCR serotyping from pediatric parapneumonic effusions. BMC Pediatr 2014; 14:189. [PMID: 25060939 PMCID: PMC4118202 DOI: 10.1186/1471-2431-14-189] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 07/14/2014] [Indexed: 12/25/2022] Open
Abstract
Background To determine the serotypes of Streptococcus pneumoniae responsible for pneumonia complicated by parapneumonic effusion in children, we performed real-time PCR based pneumococcal “serotyping” directly on parapneumonic fluid samples. Methods Specimens were collected at two children’s hospitals in Ontario, Canada from 2009 to 2011. Samples in which S. pneumoniae was detected by PCR were tested with serotype-specific 5′exonuclease PCR assays for the 13 serotypes contained in the 13-serotype pneumococcal vaccine. Results Thirty-five S. pneumoniae PCR-positive pleural samples were studied. Pneumococcal serotyping PCR assays were positive for 34 of 35 (97%). Serotype 3 was detected most frequently, in 19/35 (54%), followed by serotype 19A in 9/35 (26%), serotype 7 F/A in 4/35 (11%), serotype 1 in 1/35 (3%), and serotype 6A also in 1/35 (3%). Conclusions PCR testing demonstrated that the vast majority (97%) of S. pneumoniae parapneumonic effusions were caused by serotypes present in the 13-serotype vaccine that were not present in the original 7 serotype vaccine. This suggests that use of the 13-serotype vaccine could potentially prevent many S. pneumoniae pneumonias complicated by parapneumonic effusion in our region, provided serotype replacement does not occur.
Collapse
Affiliation(s)
- Robert Slinger
- Department of Laboratory Medicine and Pathology and Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada.
| | | | | | | | | |
Collapse
|
65
|
Feris-Iglesias J, Fernández J, Sánchez J, Pimenta F, Peña C, Coradin H, Perez-Then E, Peinado M, Floren A, Del Moral T, Erdman D, da Gloria Carvalho M, Verani JR. Aetiology of paediatric pneumonia with effusion in the Dominican Republic and the potential impact of pneumococcal conjugate vaccines. Pneumonia (Nathan) 2014; 4:8-15. [PMID: 29725575 PMCID: PMC5922323 DOI: 10.15172/pneu.2014.4/413] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 03/26/2014] [Indexed: 12/20/2022] Open
Abstract
Pleural effusion is a serious complication of pneumonia, and Streptococcus pneumoniae is a leading cause. We describe the aetiology of pneumonia with effusion among children in the Dominican Republic before the introduction of the 13-valent pneumococcal conjugate vaccine (PCV) in 2013 and the performance characteristics of a rapid immunochromatographic test (ICT) for detecting S. pneumoniae in pleural fluid. From July 2009 to June 2011, we enrolled children <15 years old admitted with pneumonia and pleural effusion to Robert Reid Cabral Children’s Hospital, Dominican Republic. Pleural fluid was tested by culture, polymerase chain reaction (PCR) for bacterial (S. pyogenes, S. pneumoniae) and viral (respiratory syncytial virus and human rhinovirus) pathogens, and by ICT for S. pneumoniae. We calculated the performance of ICT and culture compared with PCR. Among 121 cases, the median age was 31 months (range 1 week to 14 years). Pleural fluid culture (n = 121) and PCR testing (n = 112) identified an aetiology in 85 (70.2%) cases, including 62 S. pneumoniae (51.2%) and 19 Staphylococcus aureus (15.7%). The viruses tested were not detected. The most prevalent pneumococcal serotypes were 14 (n = 20), 1 (n = 13), and 3 (n = 12). Serotype coverage of the 10- and 13-valent PCVs would be 70.5% and 95.1%, respectively. The sensitivity of point-of-care ICT was 100% (95% confidence interval [CI] 94.1%–100%), while specificity was 86.3% (95% CI 73.7%–94.3%). S. pneumoniae caused more than half of paediatric pneumonia with effusion cases; introduction of PCV in the Dominican Republic could reduce the burden by 36–49%. ICT is a practical, valid diagnostic tool for clinical care and surveillance in settings with limited laboratory capacity.
Collapse
Affiliation(s)
- Jesús Feris-Iglesias
- Department of infectious Diseases, Dr. Robert Reid Cabral Children's Hospital, Santo Domingo, Dominican Republic Ave. Abraham Lincoln 2, ZP 0002
| | - Josefina Fernández
- Department of infectious Diseases, Dr. Robert Reid Cabral Children's Hospital, Santo Domingo, Dominican Republic Ave. Abraham Lincoln 2, ZP 0002
| | - Jacqueline Sánchez
- Department of infectious Diseases, Dr. Robert Reid Cabral Children's Hospital, Santo Domingo, Dominican Republic Ave. Abraham Lincoln 2, ZP 0002
| | - Fabiana Pimenta
- 22Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Chabela Peña
- Department of infectious Diseases, Dr. Robert Reid Cabral Children's Hospital, Santo Domingo, Dominican Republic Ave. Abraham Lincoln 2, ZP 0002
| | - Hilma Coradin
- Department of infectious Diseases, Dr. Robert Reid Cabral Children's Hospital, Santo Domingo, Dominican Republic Ave. Abraham Lincoln 2, ZP 0002
| | - Eddy Perez-Then
- Department of infectious Diseases, Dr. Robert Reid Cabral Children's Hospital, Santo Domingo, Dominican Republic Ave. Abraham Lincoln 2, ZP 0002
| | | | | | | | - Dean Erdman
- 22Centers for Disease Control and Prevention, Atlanta, GA USA
| | | | | |
Collapse
|
66
|
Deceuninck G, Quach C, Panagopoulos M, Thibeault R, Côté-Boileau T, Tapiéro B, Coïc L, De Wals P, Ovetchkine P. Pediatric Pleural Empyema in the Province of Quebec: Analysis of a 10-Fold Increase Between 1990 and 2007. J Pediatric Infect Dis Soc 2014; 3:119-26. [PMID: 26625364 DOI: 10.1093/jpids/pit075] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 08/19/2013] [Indexed: 11/13/2022]
Abstract
BACKGROUND Although the frequency of pneumonia has decreased over time, an increase in pleural empyema has been observed in different settings worldwide. This study assessed the epidemiology of community-acquired pediatric pleural empyema in the province of Quebec through validation of cases found in a hospitalization discharge database. METHODS We used the national administrative database of hospitalization to identify children (6 months-14 years) hospitalized for pleural empyema or pleural effusion with drainage from January 1990 until December 2007 and reviewed their medical charts. Patients with pleural effusion secondary to chest trauma, thoracic surgery, malignancies, cardiac failure, or metabolic disorders were excluded. RESULTS Predictive positive value (PPV) of empyema code in any position among discharge diagnostics in the administrative database was 86.5% (95% confidence interval: 81.9%-90.3%). After chart revision, 292 met the inclusion criteria. Age-adjusted incidence of pleural empyema in the pediatric population increased from 0.23 in 1990 to 4.01/100,000 person-years in 2007. A bacterial pathogen was identified in 46.5%; Streptococcus pneumoniae (Sp) (42%) and S pyogenes (30%) were most frequent. There was no obvious change in the PPV and proportions of children with chronic disease or asthma and in identified pathogens over time, but an increase in pre-admission respiratory symptoms duration (from 3.8 days to 5.7) and nonsteroidal anti-inflammatory drug use (from 0% to 19%) was observed. CONCLUSIONS From 1990 to 2007, we observed a 10-fold increase in the incidence of pediatric hospitalizations associated with pleural empyema. This increase preceded the introduction of a pneumococcal conjugated vaccine program in Quebec. Sp remained the major pathogen identified.
Collapse
Affiliation(s)
| | - Caroline Quach
- Division of Infectious Diseases, Department of Pediatrics and Medical Microbiology, The Montreal Children's Hospital and McGill University, and
| | - Markos Panagopoulos
- Division of Infectious Diseases, Department of Pediatrics, CHU-Sainte-Justine and University of Montreal, Montreal, Quebec, Canada
| | - Roseline Thibeault
- Division of Infectious Diseases, Department of Pediatrics, CHU Quebec and Laval University, Quebec City, Quebec, Canada
| | | | - Bruce Tapiéro
- Division of Infectious Diseases, Department of Pediatrics, CHU-Sainte-Justine and University of Montreal, Montreal, Quebec, Canada
| | - Léna Coïc
- Division of Infectious Diseases, Department of Pediatrics, CHU-Sainte-Justine and University of Montreal, Montreal, Quebec, Canada
| | - Philippe De Wals
- Department of Social and Preventive Medicine, Laval University, Quebec City, Quebec, Canada
| | - Philippe Ovetchkine
- Division of Infectious Diseases, Department of Pediatrics, CHU-Sainte-Justine and University of Montreal, Montreal, Quebec, Canada
| |
Collapse
|
67
|
Abstract
BACKGROUND Recently published practice guidelines continue to reflect uncertainty about the comparative effectiveness of various treatments for empyema in children. We describe treatment trends and outcomes in pediatric empyema using the most current nationally representative data. METHODS Using survey methods and Kids' Inpatient Databases from 1997 to 2009, we evaluated hospital stays in children 0-18 years of age. We used 2009 data to compare transfer-out rates and lengths of stay across various types of treatment, after adjusting for patient and hospital factors. RESULTS From 1997 to 2009, empyema discharges steadily increased from 3.1 to 6.0 per 100,000 children (P < 0.001 for trend) and also were increasingly likely (P < 0.01) to be coded for: (1) at least 1 pleural drainage procedure (76.4-83.2%), (2) multiple drainage procedures (36.0-41.6%) and (3) home health care (8.7-15.0%). By 2009, video-assisted thoracoscopic surgery was more commonly coded than chest tube drainage and was associated with a lower transfer-out rate (0.6% vs. 10.1%, adjusted P < 0.001) but no reduction in mean length of stay [11.2 vs. 13.4 days, adjusted incidence rate ratio 0.95 (95% confidence interval: 0.88-1.04)] for children neither admitted nor discharged by transfer. CONCLUSIONS US hospital stays for empyema in children not only continued to increase through 2009 but were also characterized by more intense procedural management. Outcomes results in this population-based study are consistent with practice guidelines and recommendations that recently endorsed chest tube drainage as an acceptable first treatment option for most children with empyema.
Collapse
|
68
|
Bonsignori F, Chiappini E, Orlandini E, Parretti A, Sollai S, Resti M, Galli L, Azzari C, De Martino M. Hospitalization rates of complicated pneumococcal community-acquired pneumonia is increasing in Tuscan children. Int J Immunopathol Pharmacol 2014; 26:995-1005. [PMID: 24355238 DOI: 10.1177/039463201302600421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
To provide epidemiological data on community-acquired pneumonia (CAP) and complicated CAP, a retrospective study was conducted on a partially vaccinated paediatric population. Data from children hospitalized for CAP in Tuscan hospitals between January 1st, 1999 and December 31st, 2009 were analysed. A total of 5,450 children with CAP were hospitalized. Annual hospitalization rates for CAP did not change significantly over the study period (X2 for trend= 0.652; p=0.419). The total annual hospitalization rate for pneumococcal CAP varied according to age (28.04 per 100,000 children aged less than 5 years, 10.06 per 100,000 children aged 6-12 years and 0.98 per 100,000 children aged greater than13years). Hospitalization rates for pneumococcal CAP increased from12.84 (95 percent CI:7.35-18.34) in 2001 to 45.4 (95 percent CI:35.93-54.90) per 100,000 children aged less than 5 years in 2009 (p less than 0.0001). In addition, a significant increase of hospitalization rates for complicated CAP (from 6.07 in 1999 to 13.66 in 2009 per 100,000 children; P less than 0.0001) and pneumococcal complicated CAP (from 0.19 in 1999 to 3.41 in 2009 per 100,000 children) over the study period were highlighted. Our epidemiological data confirm the decision to introduce the PCV13 vaccine, to satisfy the need to prevent a wider group of pneumococcal serotypes.
Collapse
Affiliation(s)
- F Bonsignori
- Department of Sciences for Woman and Childs Health, Anna Meyer Childrens University Hospital, Florence, Italy
| | - E Chiappini
- Department of Sciences for Woman and Childs Health, Anna Meyer Childrens University Hospital, Florence, Italy
| | - E Orlandini
- Department of Sciences for Woman and Childs Health, Anna Meyer Childrens University Hospital, Florence, Italy
| | - A Parretti
- Department of Sciences for Woman and Childs Health, Anna Meyer Childrens University Hospital, Florence, Italy
| | - S Sollai
- Department of Sciences for Woman and Childs Health, Anna Meyer Childrens University Hospital, Florence, Italy
| | - M Resti
- Department of Sciences for Woman and Childs Health, Anna Meyer Childrens University Hospital, Florence, Italy
| | - L Galli
- Department of Sciences for Woman and Childs Health, Anna Meyer Childrens University Hospital, Florence, Italy
| | - C Azzari
- Department of Sciences for Woman and Childs Health, Anna Meyer Childrens University Hospital, Florence, Italy
| | - M De Martino
- Department of Sciences for Woman and Childs Health, Anna Meyer Childrens University Hospital, Florence, Italy
| |
Collapse
|
69
|
Thoracic empyema in children: Clinical presentation, microbiology analysis and therapeutic options. J Infect Chemother 2014; 20:262-5. [DOI: 10.1016/j.jiac.2013.12.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Revised: 12/15/2013] [Accepted: 12/25/2013] [Indexed: 11/24/2022]
|
70
|
Abstract
PURPOSE OF REVIEW The aim of this review is to highlight recent changes concerning the incidence of empyema. In this article we have focused on community-acquired empyema RECENT FINDINGS The incidence of empyema seems to have been increasing both in children and adults worldwide in the past decades, mainly in healthy young adults and in older patients. The bacteriology of pleural infection is changing as well. In children, the most common microorganism that causes empyema continues to be Streptococcus pneumoniae. Interestingly, the widespread use of the seven valent conjugate vaccine has produced a replacement phenomenon with the emergence of some pneumococcal serotypes such as serotypes 1, 3 and 19A, which have a higher propensity to cause empyema. Moreover increases in the incidence of empyema due to Staphylococcus aureus have also been observed. In adults, increases in the rate of empyema due to Streptococcus milleri group and S. aureus have been reported. SUMMARY Continued surveillance in the epidemiology of empyema is needed. Progress in new strategies of prevention, such as a new generation of conjugate pneumococcal vaccines and protein-based vaccines, could become an important step in the control of this important complication.
Collapse
|
71
|
Early Impact of 13-Valent Pneumococcal Conjugate Vaccine on Community-Acquired Pneumonia in Children. Clin Infect Dis 2014; 58:918-24. [DOI: 10.1093/cid/ciu006] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
72
|
|
73
|
Yu D, Buchvald F, Brandt B, Nielsen KG. Seventeen-year study shows rise in parapneumonic effusion and empyema with higher treatment failure after chest tube drainage. Acta Paediatr 2014; 103:93-9. [PMID: 24117621 DOI: 10.1111/apa.12426] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 08/20/2013] [Accepted: 09/19/2013] [Indexed: 12/19/2022]
Abstract
AIM To evaluate epidemiology, pre-admission characteristics and management of paediatric parapneumonic effusions (PPEs) and empyema in a tertiary paediatric pulmonary centre between 1993 and 2010. METHODS Retrospective chart review study using paediatric and thoracic database searches, with particular emphasis on pre-admission characteristics, disease stage (simple or complex effusion or empyema), general management and surgical procedures. RESULTS One hundred children were eligible, exhibiting a significant increase in incidence from 0.5 to 2.6 per 100 000 across the study period. Baseline characteristics were similar across disease stages. Streptococcus pneumoniae was the most common pathogen. Surgical intervention beyond chest tube drainage (CTD) was required in 50%; this rate showed a particular increase in children aged 0-5 years (OR, 3.1), but was otherwise not influenced by baseline characteristics, disease stage or use of intrapleural fibrinolytics. Length of hospitalisation did not differ across disease stages or primary interventional procedures. CONCLUSION This study confirmed an increasing incidence of PPEs and empyema in a Scandinavian tertiary paediatric pulmonary centre. Young children exhibited higher treatment failure after CTD. Length of hospitalisation was similar across disease stages and was comparable to previous reports according to primary interventional procedure.
Collapse
Affiliation(s)
- Danny Yu
- Paediatric Pulmonary Service; Department of Paediatrics and Adolescent Medicine; Copenhagen University Hospital; Rigshospitalet; Copenhagen Denmark
| | - Frederik Buchvald
- Paediatric Pulmonary Service; Department of Paediatrics and Adolescent Medicine; Copenhagen University Hospital; Rigshospitalet; Copenhagen Denmark
| | - Bodil Brandt
- Department of Thoracic Surgery; The Heart and Lung Surgical Clinic; Copenhagen University Hospital; Rigshospitalet; Copenhagen Denmark
| | - Kim G Nielsen
- Paediatric Pulmonary Service; Department of Paediatrics and Adolescent Medicine; Copenhagen University Hospital; Rigshospitalet; Copenhagen Denmark
| |
Collapse
|
74
|
Corcoran JP, Rahman NM. Point: Should Fibrinolytics Be Routinely Administered Intrapleurally for Management of a Complicated Parapneumonic Effusion? Yes. Chest 2014; 145:14-17. [DOI: 10.1378/chest.13-2354] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
75
|
Loo JD, Conklin L, Fleming-Dutra KE, Deloria Knoll M, Park DE, Kirk J, Goldblatt D, O'Brien KL, Whitney CG. Systematic review of the effect of pneumococcal conjugate vaccine dosing schedules on prevention of pneumonia. Pediatr Infect Dis J 2014; 33 Suppl 2:S140-51. [PMID: 24336056 PMCID: PMC3944478 DOI: 10.1097/inf.0000000000000082] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pneumonia is the leading cause of morbidity and mortality among children <5 years of age globally. Pneumococcal conjugate vaccines (PCVs) are known to provide protection against vaccine serotype pneumococcal pneumonia; uncertainty exists regarding the optimum PCV dosing schedule. METHODS We conducted a systematic review of studies published from 1994 to 2010 (supplemented post hoc with studies from 2011) documenting the effect of PCV dosing schedules on clinical and radiologically confirmed pneumonia, pneumococcal pneumonia and empyema among children of ages targeted to receive vaccine. Data on 2- and 3-dose schedules were included. Percent change of pneumonia incidence rates from baseline to most recent year post-PCV introduction was calculated. RESULTS We identified 42 primary citations that evaluated PCV schedules and pneumonia. Thirty-seven (88%) were from North America, Europe or Australia; 37 (88%) evaluated PCV7 and 1 (2%) PCV10. Two studies (both observational) compared multiple schedules within the study. We found evidence of reduced clinical and radiologically confirmed pneumonia incidence for all schedules, including 2+1 (1 nonrandomized trial, 5 observational studies), 3+0 (5 randomized trials, 2 observational studies) and 3+1 (5 clinical trials, 24 observational studies) schedules. The magnitude of disease impact did not differ among schedules. Evidence for impact on pneumococcal pneumonia and empyema varied. CONCLUSIONS All schedules (2+1, 3+0 and 3+1) reduced clinical and radiologically confirmed pneumonia. Quantifying differences in pneumonia disease impact between schedules was difficult due to heterogeneity among studies in design, case definition and population. These findings support World Health Organization recommendations for 3-dose schedules administered as either 3+0 or 2+1 regimens. Pneumonia impact data are still needed on expanded serotype PCV products, developing country settings and the role for a booster dose.
Collapse
Affiliation(s)
- Jennifer D Loo
- From the *Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunizations and Respiratory Diseases; †Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA; ‡International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; §Westat Inc., Rockville, MD; and ¶Institute of Child Health, University College London, London, United Kingdom
| | | | | | | | | | | | | | | | | |
Collapse
|
76
|
Krzyściak W, Pluskwa KK, Jurczak A, Kościelniak D. The pathogenicity of the Streptococcus genus. Eur J Clin Microbiol Infect Dis 2013; 32:1361-76. [PMID: 24141975 PMCID: PMC3824240 DOI: 10.1007/s10096-013-1914-9] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 06/11/2013] [Indexed: 12/11/2022]
Abstract
Streptococcus infections are still one of the important problems facing contemporary medicine. As the World Health Organization (WHO) warns, Streptococcus pneumoniae is responsible for the highest number of pneumonia cases all over the world. Despite an increasing number of pneumococcal vaccinations, incidences of disease connected to this pathogen's infection stay at the same level, which is related to a constantly increasing number of infections caused by nonvaccinal serotypes. Unfortunately, the pathogenicity of bacteria of the Streptococcus genus is also connected to species considered to be physiological flora in humans or animals and, additionally, new species exhibiting pathogenic potential have been discovered. This paper presents an opinion concerning the epidemiology of streptococci infections based on case studies and other publications devoted to this problem. It also sheds new light based on recent reports on the prevention of protective vaccinations application in the case of streptococci infections.
Collapse
Affiliation(s)
- W Krzyściak
- Department of Medical Diagnostics, Pharmacy Faculty, Jagiellonian University Medical College, 9 Medyczna St., 30-688, Krakow, Poland,
| | | | | | | |
Collapse
|
77
|
|
78
|
Corcoran JP, Hallifax R, Rahman NM. Advances in the management of pleural disease. Expert Rev Respir Med 2013; 7:499-513. [PMID: 24138694 DOI: 10.1586/17476348.2013.838016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pleural disease affects over 3000 people per million population annually. Consequently, it represents a significant proportion of the respiratory physician's workload and can present to clinicians of all backgrounds in primary and secondary care. Pleural effusions have been reported in association with over 50 different conditions; some related to specific pulmonary pathologies, but many being manifestations of multisystem disease. The burden that conditions such as pleural infection; malignant pleural disease; and pneumothorax impose on patients and health care systems is enormous and growing. As such, a clear understanding of these key conditions is crucial to any physician regardless of the specialty. This article addresses a number of areas relating to pleural disease, providing an overview of the diagnostic and therapeutic advances that have been made in our understanding of pleural pathology in recent years. The directions that future research in this important area of respiratory medicine might take will also be discussed.
Collapse
Affiliation(s)
- John P Corcoran
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals, Oxford, OX3 7LE, UK and
| | | | | |
Collapse
|
79
|
Abstract
Community-acquired pneumonia (CAP) remains a frequent cause of morbidity and mortality worldwide even in industrialised countries, and its incidence is highest among children aged <5 years. Over the last two years, three international guidelines have been updated with new evidence concerning the incidence, aetiology and management of childhood CAP, but there are still some major problems in standardisation. The main aim of this review is to consider the available data concerning the aetiology, diagnosis, evaluation of severity, and treatment of paediatric CAP. Analysis of the literature shows that there are a number of unanswered questions concerning the management of CAP, including its definition, the absence of a paediatric CAP severity score, the difficulty of identifying its aetiology, the emergence of resistance of the most frequent respiratory pathogens to the most widely used anti-infectious agents, and the lack of information concerning the changes in CAP epidemiology following the introduction of vaccines against respiratory pathogens. More research is clearly required in various areas, and further efforts are needed to increase vaccination coverage with the already available vaccines in order to reduce the occurrence of the disease.
Collapse
Affiliation(s)
- Fabio Cardinale
- Pediatric Unit, Division of Pulmonology, Allergy, and Immunology, AOU "Policlinico-Giovanni XXIII", Bari, Italy.
| | - Anna Rita Cappiello
- Pediatric Unit, Division of Pulmonology, Allergy, and Immunology, AOU “Policlinico-Giovanni XXIII”, Bari, Italy
| | - Maria Felicia Mastrototaro
- Pediatric Unit, Division of Pulmonology, Allergy, and Immunology, AOU “Policlinico-Giovanni XXIII”, Bari, Italy
| | - Mariacristina Pignatelli
- Pediatric Unit, Division of Pulmonology, Allergy, and Immunology, AOU “Policlinico-Giovanni XXIII”, Bari, Italy
| | - Susanna Esposito
- Pediatric Clinic 1, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|
80
|
Weil Olivier C. Ten years of experience with the pneumococcal conjugate 7-valent vaccine in children. Med Mal Infect 2013; 43:309-21. [DOI: 10.1016/j.medmal.2013.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Revised: 03/11/2013] [Accepted: 04/25/2013] [Indexed: 11/30/2022]
|
81
|
Corcoran JP, Hallifax R, Rahman NM. New therapeutic approaches to pleural infection. Curr Opin Infect Dis 2013; 26:196-202. [PMID: 23286936 DOI: 10.1097/qco.0b013e32835d0b71] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Pleural infection is a common and serious clinical problem that because of its high morbidity and mortality imposes a significant burden on clinicians, healthcare resources and patients of all ages. Defining the optimal management strategy for pleural infection remains a cause for research and debate. This review considers the areas of interest including bacteriology and antibiotic selection, intrapleural fibrinolytics and the role of surgery. RECENT FINDINGS Pleural infection is increasing in the adult and paediatric populations without clear explanation and with clinical and financial consequences. The bacteriology of pleural infection is recognized as being unique from parenchymal lung infection with implications for its treatment. Although established in paediatric management, intrapleural fibrinolytics remain of uncertain benefit in adults, though the novel combination of tissue plasminogen activator and deoxyribonuclease used in the MIST2 study offers cause for optimism. Surgery remains a key intervention in pleural infection, but its precise role is unclear with no robust evidence to show when and in whom it should be optimally utilized. SUMMARY The high mortality in adults from pleural infection despite advances in clinical knowledge, diagnostics and therapeutics highlights the need for ongoing research. Future studies are required to focus on improving the clinical outcomes, with the identification of those patients at greatest risk of poor outcomes at presentation and most likely to benefit from more radical treatment a priority to allow the delivery of individualized care.
Collapse
Affiliation(s)
- John P Corcoran
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals, Oxford, UK
| | | | | |
Collapse
|
82
|
Abstract
BACKGROUND Hemolytic uremic syndrome (HUS) is usually associated with diarrheal illness but can also occur in children with Streptococcus pneumoniae infection (SpHUS), particularly those with complicated pneumonia. Based on recent reports that hospital discharges for complicated pneumococcal pneumonia are increasing in US children, we studied whether discharges for SpHUS might also be increasing. METHODS We used the Kids' Inpatient Database samples from 1997, 2000, 2003, 2006 and 2009 to estimate trends in US hospital discharges of children (0-18 years) for whom diagnosis codes indicated invasive pneumococcal disease, HUS, or both (SpHUS). Univariate and multivariate analyses were based on 2009 discharges. RESULTS During the 5 study years, annual numbers of US hospital discharges for SpHUS approximately doubled (P = 0.025 for linear trend) and cumulatively totaled an estimated 211 discharges. In 2009, SpHUS accounted for 4.6% (95% confidence interval [CI]: 3.0%-6.7%) of HUS discharges, 0.7% (95% CI: 0.5%-1.0%) of invasive pneumococcal disease discharges and 3.0% (95% CI: 2.0%-3.9%) of discharges for complicated pneumococcal pneumonia. Discharges for SpHUS were more likely than those for other invasive pneumococcal disease to occur in children <3 years of age and to incur longer length of stay and greater hospital charges. SpHUS was independently associated with pneumococcal sepsis/bacteremia (age-adjusted odds ratio 3.8; 95% CI: 1.9-7.8) and complicated pneumonia (odds ratio 9.2; 95% CI: 4.1-20.7). CONCLUSIONS SpHUS is an uncommon but severe illness that primarily affects young children and is strongly associated with complicated pneumococcal pneumonia. US hospital stays for SpHUS appear to be increasing along with those for complicated pneumococcal pneumonia.
Collapse
|
83
|
|
84
|
Abstract
Viral pathogens are commonly isolated from children with community-acquired pneumonia (CAP). Viruses like respiratory syncytial virus, human rhinovirus, human metapneumovirus, parainfluenza viruses, and influenza may act as sole pathogens or may predispose to bacterial pneumonia by a variety of mechanisms. New, emerging, or reemerging viral pathogens occasionally cause outbreaks of severe respiratory tract infection in children. The 2009–2010 H1N1 influenza virus pandemic resulted in increased rates of influenza-related hospitalizations and deaths in children. Rapid viral diagnostic tests based on antigen detection or nucleic acid amplification are increasingly available for clinical use and confirm the importance of viral infection in children hospitalized with CAP. Recently published guidelines for the management of CAP in children note that positive viral test results can modify clinical decision making in children with suspected pneumonia by allowing antibacterial therapy to be withheld in the absence of clinical, laboratory, or radiographic findings that suggest bacterial coinfection.
Collapse
Affiliation(s)
- Charles R Woods
- Pediatric Infectious Diseases, University of Louisville School of Medicine, 571 South Floyd Street, Suite 321, Louisville, KY, 40202, USA,
| | | |
Collapse
|
85
|
Xirogianni A, Tsolia M, Voyiatzi A, Sioumala M, Makri A, Argyropoulou A, Paniara O, Markoulatos P, Kourea-Kremastinou J, Tzanakaki G. Diagnosis of Upper and Lower Respiratory Tract Bacterial Infections with the Use of Multiplex PCR Assays. Diagnostics (Basel) 2013; 3:222-31. [PMID: 26835676 PMCID: PMC4665534 DOI: 10.3390/diagnostics3020222] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 03/08/2013] [Accepted: 03/21/2013] [Indexed: 11/16/2022] Open
Abstract
The investigation of respiratory infections by molecular techniques provides important information about the epidemiology of respiratory disease, especially during the post-vaccination era. The objective of the present study was the detection of bacterial pathogens directly in clinical samples from patients with upper and lower respiratory tract infections using multiplex polymerase chain reaction (PCR) assays developed in our laboratory. Clinical samples taken over a three-year period (2007–2009) and obtained from 349 patients (adults (n = 66); children (n = 283)) with signs and symptoms of certain upper or lower respiratory tract infections, consisted of: bronchoalveolar lavages (BAL, n = 83), pleural fluids (n = 29), and middle-ear aspirates (n = 237). Overall, 212 samples (61%) were confirmed by culture and/or PCR. Among the positive samples, Streptococcus pneumoniae (mainly serotype 3) was predominant (104/212; 49.0%), followed by non-typable Haemophilus influenzae (NTHi) 59/212; 27.8%) and Streptococcus pyogenes (47/212; 22%). Haemophilus influenzae type b was detected in only three samples. The underlying microbiology of respiratory infections is gradually changing in response to various selective pressures, such as vaccine use and antibiotic consumption. The application of multiplex PCR (mPCR) assays is particularly useful since it successfully identified the microorganisms implicated in acute otitis media or lower respiratory tract infections in nearly 75% of patients with a positive result compared to conventional cultures. Non-culture identification of the implicated pneumococcal serotypes is also an important issue for monitoring pneumococcal infections in the era of conjugate pneumococcal vaccines.
Collapse
Affiliation(s)
- Athanasia Xirogianni
- National Meningitis Reference Laboratory, National School of Public Health, 196, Alexandras Avenue, Athens 11521, Greece.
- School of Health Sciences, Department of Biochemistry and Biotechnology, University of Thessaly, Ploutonos 26 & Aiolou str, Larissa 41221, Greece.
| | - Maria Tsolia
- Second Department of Pediatrics, University of Athens School of Medicine, P. and A. Kyriakou Children's Hospital, Thevon & Levadeias str, Athens 11527, Greece.
| | - Aliki Voyiatzi
- Penteli's Children's Hospital, Microbiology Laboratory, 8 Ippokratous str., Penteli, Attiki 15236, Greece.
| | - Maria Sioumala
- National Meningitis Reference Laboratory, National School of Public Health, 196, Alexandras Avenue, Athens 11521, Greece.
| | - Antonia Makri
- Penteli's Children's Hospital, Microbiology Laboratory, 8 Ippokratous str., Penteli, Attiki 15236, Greece.
| | - Athina Argyropoulou
- "Evaggelismos" General Hospital of Athens, Microbiology Laboratory, 45-47 Ipsilantou Str, Athens 10676, Greece.
| | - Olga Paniara
- "Evaggelismos" General Hospital of Athens, Microbiology Laboratory, 45-47 Ipsilantou Str, Athens 10676, Greece.
| | - Panayotis Markoulatos
- School of Health Sciences, Department of Biochemistry and Biotechnology, University of Thessaly, Ploutonos 26 & Aiolou str, Larissa 41221, Greece.
| | - Jenny Kourea-Kremastinou
- National Meningitis Reference Laboratory, National School of Public Health, 196, Alexandras Avenue, Athens 11521, Greece.
| | - Georgina Tzanakaki
- National Meningitis Reference Laboratory, National School of Public Health, 196, Alexandras Avenue, Athens 11521, Greece.
| |
Collapse
|
86
|
Abstract
BACKGROUND Estimates of the disease burden from childhood pneumonia are available for most developed countries, but they are based mainly on models. Measured country-specific pneumonia burden data are limited to a few nations and differ in case definitions and case ascertainment methods. This review describes pneumonia disease burden in developed countries. METHODS We reviewed studies describing childhood pneumonia incidence in North America, Europe, Australia, New Zealand and Japan. Available estimates suggest that each year in developed countries there are up to 2.6 million cases of pneumonia, including 1.5 million hospitalized cases and around 3000 pneumonia deaths (compared with approximately 640 annual deaths from meningitis) in children <5 years of age. RESULTS Data to inform policy decisions would be improved by information on burden and etiology of severe pneumonia, population-based incidence of ambulatory visits and hospitalizations and prevalence of complications and sequelae.
Collapse
|
87
|
Abstract
BACKGROUND AND OBJECTIVE Population-based data on pleural infections are limited. This study describes the temporal trends in the incidence, management and outcomes of pleural infections in Taiwan. METHODS The Taiwan National Health Insurance Research Database was used to analyse data on 26,385 patients with a first episode of pleural infection between 1997 and 2008. RESULTS During the study period, the median age of the patients increased from 60 to 65 years. The majority of patients were men (75%); this proportion remained constant over time. The standardized annual incidence of pleural infection increased from 5.2 per 100,000 in 1997 and reached a plateau of 8.4 to 9.6 per 100,000 between 2002 and 2008. Over time, there was an increase in the use of computed tomography (from 47.3% in 1997-1998 to 59.4% in 2007-2008), pigtail catheters (from 1.5% to 18.9%), fibrinolytics (from 0.9% to 9.3%) and surgery (from 27.7% to 33.6%), to treat pleural infections. Furthermore, the use of life-support resources, including haemodialysis, mechanical ventilation and intensive care, also increased by 3.1%, 11.0% and 12.8%, respectively. Median hospital charges per patient increased by 63.6% over the 12 years. Although the proportion of patients with organ dysfunction (i.e. severe sepsis) increased from 26.5% to 47.7%, 30-day mortality decreased from 15.0% to 13.1% (P-value for trend = 0.001). CONCLUSIONS These findings suggest that advances in the management of pleural infections and subsequent severe sepsis may have led to a reduction in the risk of short-term mortality in Taiwan.
Collapse
Affiliation(s)
- Hsiu-Nien Shen
- Department of Intensive Care Medicine, Chi Mei Medical Center, Yong-Kang Region, Tainan, Taiwan.
| | | | | |
Collapse
|
88
|
Nagy B, Gaspar I, Papp A, Bene Z, Nagy B, Voko Z, Balla G. Efficacy of methylprednisolone in children with severe community acquired pneumonia. Pediatr Pulmonol 2013; 48:168-75. [PMID: 22588852 DOI: 10.1002/ppul.22574] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 02/14/2012] [Accepted: 02/29/2012] [Indexed: 11/06/2022]
Abstract
BACKGROUND The clinical value of adjuvant corticosteroid treatment in community-acquired pneumonia (CAP) seemed to be controversial in adults, and even less data are available on the use of corticosteroids in children with CAP. MATERIALS AND METHODS In this study, we investigated the efficacy of a 5-day adjuvant methylprednisolone therapy to imipenem in 29 children with severe CAP. In parallel, 30 subjects with the same disease were treated with imipenem and placebo, and the two study groups were compared based on the different parameters of the primary and secondary end points. The primary end points were the duration of fever, the levels of white blood cells (WBC) and high sensitive C-reactive protein (hsCRP). Secondary end points were the length of hospital stay, and the number of severe complications with or without surgical interventions. RESULTS The additive methylprednisolone treatment significantly reduced the duration of fever with 2.5 days, the WBC counts (P = 0.014), the hsCRP levels showing a 48.7% decrease, and the length of hospital stay with 5.2 days versus the placebo group. Moreover, patients treated on imipenem alone had twice more complications and four times more invasive interventions compared to those on the combined therapy. CONCLUSIONS The 5-day methylprednisolone therapy with imipenem was found effective in children having severe CAP. However, trials with larger cohorts are needed to study further beneficial effects of corticosteroids in children with CAP.
Collapse
Affiliation(s)
- Bela Nagy
- Department of Pediatrics, Medical and Health Science Center, University of Debrecen, Debrecen, Hungary.
| | | | | | | | | | | | | |
Collapse
|
89
|
Esposito S, Marchese A, Tozzi AE, Rossi GA, Da Dalt L, Bona G, Pelucchi C, Schito GC, Principi N. DNA bacterial load in children with bacteremic pneumococcal community-acquired pneumonia. Eur J Clin Microbiol Infect Dis 2013; 32:877-81. [PMID: 23354677 DOI: 10.1007/s10096-013-1821-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 01/07/2013] [Indexed: 11/26/2022]
Abstract
This study was conducted to evaluate the association between pneumococcal DNA load and parapneumonic pleural effusion (PPE) in children with community-acquired pneumonia. Bacterial load was quantified and related to the presence of PPE with or without empyema in 72 otherwise healthy children aged ≤5 years who were hospitalised because of radiographically confirmed CAP and showed a real-time polymerase chain reaction that was positive for Streptococcus pneumoniae. The proportion of children with a high bacterial load (i.e. ≥265 DNA copies/mL) was larger among the subjects with PPE than those without it. Multivariate analysis showed that a high bacterial load was significantly associated with PPE (OR 8.65; 95% CI 1.10-67.8 vs a bacterial load of <125 copies/mL). Children with infection due to pneumococcal serotype 19A were at highest risk of developing PPE (OR 7.44; 95% CI 1.10-50.4 vs all other typeable serotypes). The patients with CAP due to pneumococcal serotypes that are not included in the 13-valent conjugate vaccine (PCV13) were more frequently affected by PPE than those with infections associated with serotypes included in the vaccine, except for serotype 19A. Bacterial loads of ≥265 DNA copies/mL are significantly associated with PPE, and serotype 19A is significantly associated with a high bacterial load and the development of PPE. The mean bacterial load of the patients with empyema was higher than that of patients with simple PPE. Although further studies are required, it seems that serotypes not included in PCV13 can play a major role in causing a higher bacterial load and PPE.
Collapse
Affiliation(s)
- S Esposito
- Pediatric Clinic 1, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122 Milan, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
90
|
Williams DJ, Shah SS. Community-Acquired Pneumonia in the Conjugate Vaccine Era. J Pediatric Infect Dis Soc 2012; 1:314-28. [PMID: 26619424 PMCID: PMC7107441 DOI: 10.1093/jpids/pis101] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 10/05/2012] [Indexed: 12/27/2022]
Abstract
Community-acquired pneumonia (CAP) remains one of the most common serious infections encountered among children worldwide. In this review, we highlight important literature and recent scientific discoveries that have contributed to our current understanding of pediatric CAP. We review the current epidemiology of childhood CAP in the developed world, appraise the state of diagnostic testing for etiology and prognosis, and discuss disease management and areas for future research in the context of recent national guidelines.
Collapse
Affiliation(s)
- Derek J. Williams
- Division of Hospital Medicine, The Monroe Carell Jr Children's Hospital at Vanderbilt, and,Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee; Divisions of,Corresponding Author: Derek J. Williams, MD, MPH, 1161 21st Ave. South, CCC 5311 Medical Center North, Nashville, TN 37232. E-mail: derek.
| | - Samir S. Shah
- Infectious Diseases and,Hospital Medicine, Cincinnati Children's Hospital Medical Center,Department of Pediatrics, University of Cincinnati College of Medicine, Ohio
| |
Collapse
|
91
|
Pediatric invasive pneumococcal disease in the United States in the era of pneumococcal conjugate vaccines. Clin Microbiol Rev 2012; 25:409-19. [PMID: 22763632 DOI: 10.1128/cmr.00018-12] [Citation(s) in RCA: 136] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Invasive infections caused by Streptococcus pneumoniae continue to be a major cause of morbidity and mortality worldwide, especially in children under 5 years of age. In the United States, 90% of invasive pneumococcal infections in children are caused by 13 serotypes of S. pneumoniae. The licensure (in 2000) and subsequent widespread use of a heptavalent pneumococcal conjugate vaccine (PCV7) have had a significant impact on decreasing the incidence of serious invasive pneumococcal disease (IPD) in all age groups, especially in children under 2 years of age. However, the emergence of replacement non-PCV7 serotypes, especially serotype 19A, has resulted in an increase in the incidence of serious and invasive infections. In 2010, a 13-valent PCV was licensed in the United States. However, the impact that this vaccine will have on IPD remains to be seen. The objectives of this review are to discuss the epidemiology of serious and invasive pneumococcal infections in the United States in the PCV era and to review some of the pneumococcal vaccines that are in development.
Collapse
|
92
|
Selva L, Ciruela P, Blanchette K, del Amo E, Pallares R, Orihuela CJ, Muñoz-Almagro C. Prevalence and clonal distribution of pcpA, psrP and Pilus-1 among pediatric isolates of Streptococcus pneumoniae. PLoS One 2012; 7:e41587. [PMID: 22848535 PMCID: PMC3404996 DOI: 10.1371/journal.pone.0041587] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 06/22/2012] [Indexed: 01/01/2023] Open
Abstract
Streptococcus pneumoniae is the leading cause of vaccine-preventable deaths globally. The objective of this study was to determine the distribution and clonal type variability of three potential vaccine antigens: Pneumococcal serine-rich repeat protein (PsrP), Pilus-1, and Pneumococcal choline binding protein A (PcpA) among pneumococcal isolates from children with invasive pneumococcal disease and healthy nasopharyngeal carriers. We studied by Real-Time PCR a total of 458 invasive pneumococcal isolates and 89 nasopharyngeal pneumococcal isolates among children (total = 547 strains) collected in Barcelona, Spain, from January 2004 to July 2010. pcpA, psrP and pilus-1 were detected in 92.8%, 51.7% and 14.4% of invasive isolates and in 92.1%, 48.3% and 18% of carrier isolates, respectively. Within individual serotypes the prevalence of psrP and pilus-1 was highly dependent on the clonal type. pcpA was highly prevalent in all strains with the exception of those belonging to serotype 3 (33.3% in serotype 3 isolates vs. 95.1% in other serotypes; P<.001). psrP was significantly more frequent in those serotypes that are less apt to be detected in carriage than in disease; 58.7% vs. 39.1% P<.001. Antibiotic resistance was associated with the presence of pilus-1 and showed a negative correlation with psrP. These results indicate that PcpA, and subsequently Psrp and Pilus-1 together might be good candidates to be used in a next-generation of multivalent pneumococcal protein vaccine.
Collapse
Affiliation(s)
- Laura Selva
- Molecular Microbiology Department, University Hospital Sant Joan de Deu, Barcelona, Spain
| | - Pilar Ciruela
- General Directorate of Public Health, Government of Catalonia, Spain
| | - Krystle Blanchette
- Department of Microbiology and Immunology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States of America
| | - Eva del Amo
- Molecular Microbiology Department, University Hospital Sant Joan de Deu, Barcelona, Spain
| | - Roman Pallares
- Department of Infectious Diseases, Idibell, Ciberes, Hospital Bellvitge, University of Barcelona, L’Hospitalet, Barcelona, Spain
| | - Carlos J. Orihuela
- Department of Microbiology and Immunology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States of America
| | - Carmen Muñoz-Almagro
- Molecular Microbiology Department, University Hospital Sant Joan de Deu, Barcelona, Spain
- * E-mail:
| |
Collapse
|
93
|
Hospitalized children with pneumonia in Uruguay: Pre and post introduction of 7 and 13-valent pneumococcal conjugated vaccines into the National Immunization Program. Vaccine 2012; 30:4934-8. [DOI: 10.1016/j.vaccine.2012.05.054] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 04/30/2012] [Accepted: 05/21/2012] [Indexed: 11/22/2022]
|
94
|
|
95
|
|
96
|
Smith MJ, Kong M, Cambon A, Woods CR. Effectiveness of antimicrobial guidelines for community-acquired pneumonia in children. Pediatrics 2012; 129:e1326-33. [PMID: 22492769 DOI: 10.1542/peds.2011-2412] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To assess the effectiveness of guidelines and education on empirical therapy for community-acquired pneumonia. METHODS Administrative records for children with a primary diagnosis of pneumonia from January 2007 to September 2009 were reviewed. Antimicrobial use was measured monthly over 3 periods: (1) before creation of an antimicrobial stewardship task force (ASTF), (2) after ASTF formation but before release of guidelines for antimicrobial use, and (3) after guideline release. Antimicrobial use over time was assessed by using quasi-binomial logistic regression models that incorporated interrupted events, seasonality, and autocorrelation. Allowing calculation of immediate changes due to specific interventions and trends in use over each time period. The primary outcome was use of ampicillin as recommended in the guidelines versus ceftriaxone, the historical standard. Secondary outcomes included other antimicrobial use, length of stay, mortality, and readmission. RESULTS One thousand two hundred forty-six children met study criteria. Ampicillin use increased from 2% at baseline to 6% after ASTF formation and 44% after guideline release. Ceftriaxone use increased slightly (from 56% to 59%) after ASTF formation but decreased to 28% after guideline release. An immediate change in prescription occurred in the month after guideline publication and remained stable over the following year. CONCLUSIONS Guidelines and education can have an impact on antimicrobial use in the pediatric setting. Although the optimal strategies for pediatric antimicrobial stewardship programs still are being determined, we believe that our approach offers an inexpensive and low-risk step in the right direction.
Collapse
Affiliation(s)
- Michael J Smith
- Department of Pediatrics, University of Louisville, Louisville, Kentucky, USA.
| | | | | | | |
Collapse
|
97
|
Principi N, Esposito S. Use of the 13-valent pneumococcal conjugate vaccine in infants and young children. Expert Opin Biol Ther 2012; 12:641-8. [PMID: 22397739 DOI: 10.1517/14712598.2012.670217] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The inclusion of the heptavalent pneumococcal conjugate vaccine (PCV7) in the immunization schedule of infants and young children has greatly reduced the incidence of invasive and non-invasive diseases due to Streptococcus pneumoniae. However, as PCV7 has some limitations, new vaccines containing more pneumococcal serotypes have been developed. Only two of these have so far reached the market: a 10-valent preparation containing the PCV7 serotypes plus serotypes 1, 5 and 7F (PCV10), and a 13-valent vaccine containing the PCV7 serotypes plus serotypes 1, 3, 5, 6A, 7F and 19A (PCV13). AREAS COVERED The main aim of this review is to discuss the reasons that have led to the formulation of PCV13, its immunogenicity, safety and tolerability and the recommendations concerning its use in children. EXPERT OPINION There is no doubt that a pneumococcal conjugate vaccine with the composition of PCV13 has significantly increased the possibility of preventing pneumococcal disease. Its immunogenicity, safety and tolerability seem to be optimal, as does its cost-effectiveness. However, despite these favorable premises, it cannot be considered the final preparation for the prevention of pneumococcal disease, and it is likely that a new vaccine capable of covering all pneumococcal serotypes will be needed in the future.
Collapse
Affiliation(s)
- Nicola Principi
- Department of Maternal and Pediatric Sciences, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
| | | |
Collapse
|
98
|
|
99
|
Newman RE, Hedican EB, Herigon JC, Williams DD, Williams AR, Newland JG. Impact of a guideline on management of children hospitalized with community-acquired pneumonia. Pediatrics 2012; 129:e597-604. [PMID: 22351891 DOI: 10.1542/peds.2011-1533] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We sought to describe the impact a clinical practice guideline (CPG) had on antibiotic management of children hospitalized with community-acquired pneumonia (CAP). PATIENTS AND METHODS We conducted a retrospective study of discharged patients from a children's hospital with an ICD-9-CM code for pneumonia (480-486). Eligible patients were admitted from July 8, 2007, through July 9, 2009, 12 months before and after the CAP CPG was introduced. Three-stage least squares regression analyses were performed to examine hypothesized simultaneous relationships, including the impact of our institution\x{2019}s antimicrobial stewardship program (ASP). RESULTS The final analysis included 1033 patients: 530 (51%) before the CPG (pre-CPG) and 503 (49%) after the CPG (post-CPG). Pre-CPG, ceftriaxone (72%) was the most commonly prescribed antibiotic, followed by ampicillin (13%). Post-CPG, the most common antibiotic was ampicillin (63%). The effect of the CPG was associated with a 34% increase in ampicillin use (P < .001). Discharge antibiotics also changed post-CPG, showing a significant increase in amoxicillin use (P < .001) and a significant decrease in cefdinir and amoxicillin/clavulanate (P < .001), with the combined effect of the CPG and ASP leading to 12% (P < 0.001) and 16% (P < .001) reduction, respectively. Overall, treatment failure was infrequent (1.5% vs 1%). CONCLUSIONS A CPG and ASP led to the increase in use of ampicillin for children hospitalized with CAP. In addition, less broad-spectrum discharge antibiotics were used. Patient adverse outcomes were low, indicating that ampicillin is appropriate first-line therapy for otherwise healthy children admitted with uncomplicated CAP.
Collapse
Affiliation(s)
- Ross E Newman
- Section of General Pediatrics, Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Children’s Mercy Hospitals and Clinics, Kansas City, MO 64108, USA
| | | | | | | | | | | |
Collapse
|
100
|
Thoon KC, Chong CY, Tee NWS. Early impact of pneumococcal conjugate vaccine on invasive pneumococcal disease in Singapore children, 2005 through 2010. Int J Infect Dis 2012; 16:e209-15. [DOI: 10.1016/j.ijid.2011.11.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Revised: 07/01/2011] [Accepted: 11/30/2011] [Indexed: 12/01/2022] Open
|