David Aguilera-Alonso (Spain)
Hospital Gregorio Marañón Pediatric Infectious DiseasesPresenter of 2 Presentations
STAPHYLOCOCCUS AUREUS COMMUNITY-ACQUIRED PNEUMONIA IN CHILDREN AFTER PNEUMOCOCCAL 13-VALENT VACCINATION (2008-2018): COMPARISON WITH STREPTOCOCCUS PNEUMONIAE (NACSAPED STUDY) (ID 1102)
Abstract
Background
After introducing pneumococcal vaccination, the epidemiology of community-acquired pneumonia (CAP) in children has changed. Thus, the prevalence of non-pneumococcal bacteria, such as Staphylococcus aureus, may be increasing. Pneumococcal 13-valent vaccination was implemented in the Regional Immunization program of Madrid in 2010. We aimed to describe the epidemiology of pediatric S. aureus CAP (SA-CAP) in recent years and to compare them with the characteristics of Streptococcus pneumoniae CAP (SP-CAP).
Methods
Retrospective multicenter study including patients <17 years with bacterial CAP (S. aureus, S. pneumoniae, and Streptococcus pyogenes) admitted in 5 tertiary hospitals in Madrid (Spain) during 2008-18. For comparisons, S. pneumoniae CAP (SP-CAP) were randomly selected with a ratio 2:1 SA-CAP, comparing 34 SA-CAP with 68 SP-CAP. The annual rate of cases/10,000 admissions/year was analyzed.
Results
236/313(75.4%) bacterial pneumonia were SP-CAP, and 34/313(10.9%) SA-CAP. The annual rate of SP-CAP decreased from 14.7/10,000 admissions (2008) to 7.7/10,000 admissions (2018)(p<0.001), whereas the annual rate of SA-CAP remained stable(Figure). SP-CAP median age was higher (2.9[IQR: 1.7-4.6]years) than SA-CAP (0.7[IQR: 0.5-2.6]years)(p<0.001). Initial empiric treatment was more frequently inadequate in SA-CAP (50% vs. 1.5%,p<0.001). Viral coinfections were more commonly detected among SA-CAP(26.5% vs. 7.4%,p=0.008). A higher percentage of patients with SA-CAP required respiratory support. However, lung complications were more common among SP-CAP: pleural effusion(64.7 vs. 47.1%,p=0.088),p=0.088) and lung necrosis(32.4% vs. 5.9%,p=0.003).
Conclusions
The prevalence of SP-CAP in children decreased from 2008 to 2018, whereas S. pyogenes CAP prevalence slightly increased. Interestingly, in this population, unlike other studies, admitted SP-CAP had a higher severity than SA-CAP. Indeed, two patients with SP-CAP (2.9%) died vs. none SA-CAP.