Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nan-Li-Shi Road, Beijing, 100045, China.
Key Laboratory of Major Diseases in Children, Ministry of Education, National Key Discipline of Pediatrics (Capital Medical University), Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
Eur J Clin Microbiol Infect Dis. 2021 Sep;40(9):1833-1842. doi: 10.1007/s10096-021-04238-x. Epub 2021 Mar 31.
Invasive pneumococcal disease (IPD) is associated with significant morbidity and mortality. However, limited studies have reported clinical features of IPD cases among Chinese children. This study aimed to evaluate clinical characteristics as well as serotype distribution of hospitalized IPD children in Beijing, China. Children with confirmed IPD were retrospectively recruited from January 2014 to December 2019. Clinical data were gathered from medical records, and serotypes of Streptococcus pneumoniae isolates were detected. Clinical differences between deaths and survivors were also compared, and risk factors associated with death were determined. Of sixty-eight children diagnosed with IPD, 58 (85.3%) were < 5 years. 19F was the predominant serotype (23, 33.8%), followed by 19A (14, 20.6%), 14 (12, 17.6%), 23F (5, 7.4%), and non-vaccine serotype (NVT) 15A (3, 4.4%). The coverage rate of 13-valent pneumococcal conjugate vaccine (PCV) was 92.6% (63). After introduction of PCV-13, there was a significant increase of IPD due to NVTs (p = 0.047). Sixteen (23.5%) children died, and diagnoses of 11 (68.8%) were meningitis. Risk factors for death were < 2 years (odds ratio [OR] [95% confidence interval {CI}]: 6.64 [1.14-32.10]; p = 0.019), altered mental status (OR [95%CI]: 10.10 [2.11-48.31]; p = 0.004), and septic shock (OR [95%CI]: 6.61 [1.11-39.50]; p = 0.038). This study revealed that the case fatality rate of hospitalized IPD children was high in this hospital. Fatal cases were more likely to be children < 2 years, presented with changed mental status and septic shock. Notably, we found that NVTs increased after PCV13 availability in China.
侵袭性肺炎球菌病（IPD）与较高的发病率和死亡率相关。然而，目前仅有少数研究报道了中国儿童侵袭性肺炎球菌病的临床特征。本研究旨在评估中国北京住院儿童侵袭性肺炎球菌病的临床特征和血清型分布。本研究回顾性招募了 2014 年 1 月至 2019 年 12 月期间确诊为 IPD 的儿童。从病历中收集临床数据，并检测肺炎链球菌分离株的血清型。还比较了死亡病例和存活病例的临床差异，并确定了与死亡相关的危险因素。在 68 例确诊为 IPD 的患儿中，58 例（85.3%）年龄<5 岁。19F 是最主要的血清型（23 例，33.8%），其次是 19A（14 例，20.6%）、14（12 例，17.6%）、23F（5 例，7.4%）和非疫苗血清型 15A（3 例，4.4%）。13 价肺炎球菌结合疫苗（PCV）的覆盖率为 92.6%（63 例）。PCV-13 引入后，非疫苗血清型引起的 IPD 显著增加（p=0.047）。16 例（23.5%）患儿死亡，11 例（68.8%）诊断为脑膜炎。死亡的危险因素包括年龄<2 岁（比值比[OR] [95%置信区间 {CI}]: 6.64 [1.14-32.10]；p=0.019）、精神状态改变（OR [95%CI]：10.10 [2.11-48.31]；p=0.004）和感染性休克（OR [95%CI]：6.61 [1.11-39.50]；p=0.038）。本研究表明，该医院住院儿童侵袭性肺炎球菌病的病死率较高。死亡病例更可能为<2 岁的儿童，表现为精神状态改变和感染性休克。值得注意的是，我们发现 PCV13 在中国上市后，非疫苗血清型增加。
