AUTHOR=del Rosal Teresa , Caminoa María Belén , González-Guerrero Alba , Falces-Romero Iker , Romero-Gómez María Pilar , Baquero-Artigao Fernando , Sainz Talía , Méndez-Echevarría Ana , Escosa-García Luis , Aracil Francisco Javier , Calvo Cristina 

TITLE=Outcome of Severe Bacterial Pneumonia in the Era of Pneumococcal Vaccination

JOURNAL=Frontiers in Pediatrics

VOLUME=8

YEAR=2020

URL=https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2020.576519

DOI=10.3389/fped.2020.576519

ISSN=2296-2360

ABSTRACT=<p><bold>Introduction:</bold> After the introduction of pneumococcal conjugate vaccines, community-acquired pneumonia (CAP) caused by <italic>Streptococcus pneumoniae</italic> has decreased whereas <italic>Staphylococcus aureus</italic> and <italic>Streptococcus pyogenes</italic> could be increasing. These bacteria have been associated with high rates of complications.</p><p><bold>Aims:</bold> (1) To describe the characteristics of pediatric bacterial CAP requiring hospitalization. (2) To compare outcomes according to causative microorganisms. (3) To analyze changes in bacterial CAP rate and etiology over time.</p><p><bold>Patients and Methods:</bold> Retrospective single-center study of inpatients aged 1 month-16 years with culture-confirmed bacterial CAP in 2010-2018 in Madrid, Spain.</p><p><bold>Results:</bold> We included 64 cases (42 <italic>S. pneumoniae</italic>, 13 <italic>S. pyogenes</italic> and 9 <italic>S. aureus</italic>). Culture-confirmed CAP represented 1.48-2.33/1,000 all-cause pediatric hospital admissions, and its rate did not vary over time. However, there was a significant decrease in pneumococcal CAP in the last 3 years of the study (78% of CAP in 2010–2015 vs. 48% in 2016-18, <italic>p</italic> = 0.017). Median hospital stay was 10.5 days (interquartile range 5-19.5), 38 patients (59%) developed complications and 28 (44%) were admitted to the intensive care unit. Outcomes were similar among children with <italic>S. pneumoniae</italic> and <italic>S. aureus</italic> CAP, whereas <italic>S. pyogenes</italic> was associated with a higher risk for complications (OR 8 [95%CI 1.1-57.2]) and ICU admission (OR 7.1 [95%CI 1.7-29.1]) compared with pneumococcal CAP.</p><p><bold>Conclusion:</bold> In a setting with high PCV coverage, culture-confirmed bacterial CAP did not decrease over time and there was a relative increase of <italic>S. pyogenes</italic> and <italic>S. aureus</italic>. Children with CAP caused by <italic>S. pyogenes</italic> were more likely to develop complications.</p>