학술논문
Staphylococcus aureus Community-Acquired Pneumonia in Children After 13-Valent Pneumococcal Vaccination (2008–2018): Epidemiology, Clinical Characteristics and Outcomes
Document Type
Academic Journal
Author
Aguilera-Alonso, David; Kirchschläger Nieto, Silke; Ara Montojo, María Fátima; Sanz Santaeufemia, Francisco José; Saavedra-Lozano, Jesús; Soto, Beatriz; Caminoa, María Belén; Berzosa, Arantxa; Prieto Tato, Luis; Cercenado, Emilia; Tagarro, Alfredo; Molina Arana, David; Alonso Sanz, Mercedes; Romero Gómez, María Pilar; Chaves Sánchez, Fernando; Baquero-Artigao, Fernando
Source
The Pediatric Infectious Disease Journal. Mar 07, 2022
Subject
Language
English
ISSN
0891-3668
Abstract
BACKGROUND:: The epidemiology of community-acquired pneumonia (CAP) has changed, influenced by sociosanitary conditions and vaccination status. We aimed to analyze the recent epidemiology of bacterial CAP in hospitalized children in a setting with high pneumococcal vaccination coverage and to describe the clinical characteristics of pediatric Staphylococcus aureus CAP. METHODS:: Children <17 years old hospitalized from 2008 to 2018 with bacterial CAP in 5 tertiary hospitals in Spain were included. Cases with pneumococcal CAP were randomly selected as comparative group following a case-control ratio of 2:1 with S. aureus CAP. RESULTS:: A total of 313 bacterial CAP were diagnosed: Streptococcus pneumoniae CAP (n = 236, 75.4%), Streptococcus pyogenes CAP (n = 43, 13.7%) and S. aureus CAP (n = 34, 10.9%). Throughout the study period, the prevalence of S. pyogenes increased (annual percentage change: +16.1% [95% CI: 1.7–32.4], P = 0.031), S. pneumoniae decreased (annual percentage change: –4.4% [95 CI: –8.8 to 0.2], P = 0.057) and S. aureus remained stable. Nine isolates of S. aureus (26.5%) were methicillin-resistant. Seventeen cases (50%) with S. aureus CAP had some pulmonary complication and 21 (61.7%) required intensive care. S. pneumoniae CAP showed a trend toward higher prevalence of pulmonary complications compared with S. aureus CAP (69.1% vs. 50.0%, P = 0.060), including higher frequency of pulmonary necrosis (32.4% vs. 5.9%, P = 0.003). CONCLUSIONS:: The incidence of S. aureus CAP in children remained stable, whereas the prevalence of pneumococcal CAP decreased and S. pyogenes CAP increased. Patients with S. aureus presented a high frequency of severe outcomes, but a lower risk of pulmonary complications than patients with S. pneumoniae.