Wu Shuiyan, Guo Xubei, Xu Zhong, Han Meilin, Huang Lili, Tao Yunzhen, Li Ying, Li Yanhong, Zhang Tao, Bai Zhenjiang
Pediatric Intensive Care Unit, Children's Hospital of Soochow University, Suzhou, Jiangsu, China.
Laboratory department, Children's Hospital of Soochow University, Suzhou, Jiangsu, China.
BMC Infect Dis. 2020 Sep 4;20(1):651. doi: 10.1186/s12879-020-05382-z.
Risk factors related to mortality due to invasive pneumococcal disease (IPD) have been unveiled previously, but early clinical manifestations of IPD based on prognosis remain uncovered.
The demographic characteristics, clinical features, serotype, antibiotic susceptibility, and outcomes of 97 hospitalized children with laboratory-confirmed IPD from Suzhou, China, were collected and analyzed retrospectively.
The median age was 0.69 (0.49-1.55) years in the non-survivor group compared with 2.39 (0.90-3.81) years in the survivor group. The mortality of 97 children with laboratory-confirmed IPD was 17.5% (17/97), and 53.6% of them were aged less than 2 years. Pathogens were mainly from the blood and cerebrospinal fluid, and sepsis was the most frequent type. Statistically significant differences were found in hyperpyrexia, vomiting, anorexia, lethargy, poor perfusion of extremities, Hb level, and Plt count between the nonsurvival and survival groups. Further, the multivariate regression analysis showed that early signs, including hyperpyrexia, vomiting, anorexia, lethargy, and poor perfusion of extremities, were independent risk factors for the in-hospital mortality of children with laboratory-confirmed IPD. The mortality was also associated with antimicrobial sensitivity in pneumococcal isolates. The microbes in 1/17 (5.9%) children who were prescribed an antibiotic showed antimicrobial sensitivity in the nonsurvival group, compared with 21/80 (26.3%) children who survived. The most common serotypes identified were 6B (35.3%, 6/17), 14 (23.5%, 4/17), 19F (23.5%, 4/17), 19A (5.9%, 1/17), 23F (5.9%, 1/17), and 20 (5.9%, 1/17) in the nonsurvival group. The coverage of IPD serotypes of the 7-valent pneumococcal conjugate vaccine (PCV7) was 88.2% (15/17), while that of the 13-valent S. pneumoniae vaccine (PCV13) was 94.1% (16/17) of the coverage in the nonsurvival group.
Recurrent hyperpyrexia, vomiting, anorexia, lethargy, and poor perfusion of extremities in the early stage were independent predictors for the in-hospital mortality of children with laboratory-confirmed IPD. Appropriate use of antibiotics and PCV immunization were the keys to improve the outcome of IPD.
先前已揭示了与侵袭性肺炎球菌病（IPD）所致死亡相关的危险因素，但基于预后的IPD早期临床表现仍未被发现。
回顾性收集并分析了97例来自中国苏州的实验室确诊IPD住院儿童的人口统计学特征、临床特征、血清型、抗生素敏感性及转归情况。
非存活组儿童的中位年龄为0.69（0.49 - 1.55）岁，而存活组为2.39（0.90 - 3.81）岁。97例实验室确诊IPD儿童的死亡率为17.5%（17/97），其中53.6%年龄小于2岁。病原体主要来自血液和脑脊液，败血症是最常见的类型。非存活组和存活组在高热、呕吐、厌食、嗜睡、四肢灌注不良、血红蛋白水平及血小板计数方面存在统计学显著差异。此外，多因素回归分析显示，早期体征，包括高热、呕吐、厌食、嗜睡和四肢灌注不良，是实验室确诊IPD儿童院内死亡的独立危险因素。死亡率还与肺炎球菌分离株的抗菌敏感性有关。在非存活组中，接受抗生素治疗的1/17（5.9%）儿童的微生物显示出抗菌敏感性，而存活的儿童中有21/80（26.3%）。在非存活组中鉴定出的最常见血清型为6B（35.3%，6/17）、14（23.5%，4/17）、19F（23.5%，4/17）、19A（5.9%，1/17）、23F（5.9%，1/17）和20（5.9%，1/17）。7价肺炎球菌结合疫苗（PCV7）对IPD血清型的覆盖率在非存活组中为88.2%（15/17），而13价肺炎链球菌疫苗（PCV13）的覆盖率为94.1%（16/）。
早期反复高热、呕吐、厌食、嗜睡和四肢灌注不良是实验室确诊IPD儿童院内死亡的独立预测因素。合理使用抗生素和PCV免疫接种是改善IPD转归的关键。
