High mortality of invasive pneumococcal disease compared with meningococcal disease in critically ill children.
OBJECTIVE
To ascertain outcome, patterns of disease, incidence of concurrent infection, superinfection and penicillin resistance in children requiring intensive care for Streptococcus pneumoniae infection and compare it to a similar disease pattern, namely Neisseria meningitidis b infection.


METHODS
Prospective cohort study in a regional paediatric intensive care unit (PICU).


METHODS
Children with invasive pneumococcal and meningococcal disease requiring intensive care.


RESULTS
The study included 22 children with invasive pneumococcal disease (IPD), median age 14 months (interquartile range 3-52), median Paediatric Index of Mortality (PIM) 0.051 (0.028-0.066), median length of PICU stay 8.5 days (4-13). Four patients died, three (13.5%) attributable to IPD. Incidence of concurrent infection 27%. There were no superinfections. All S. pneumoniae were sensitive to cefotaxime; one isolate (3.7%) was resistant to penicillin. There were 186 children with meningococcal disease (MD), with a higher PIM (median 0.068, 0.033-0.108), older age (29 months, 10.7-77.9) and shorter length of PICU stay (median 3 days, 2-6). Eight (4.3%) children died from MD. Incidence of concurrent and superinfection was 18% and 6%, respectively in children with MD. All N. meningitidis cases were sensitive to cefotaxime and penicillin. The standardized mortality ratio was considerably higher with IPD (2.0) than with MD (0.52).


CONCLUSIONS
In invasive pneumococcal disease preventative measures including early recognition, immediate antibiotic therapy and vaccination need to be taken in the community, similar to the control of meningococcal disease. Invasive pneumococcal disease should command the same respect as meningococcal disease.
Thorburn
Kentigern
K
Department of Paediatric Intensive Care, Royal Liverpool Children's Hospital, Alder Hey Hospital, Liverpool, L12 2AP, UK.
Taylor
Nia
N
Lopez-Rodriguez
Lucia
L
Ashworth
Michael
M
de la Cal
Miguel Angel
MA
van Saene
Hendrik Karel Ferdinand
HK
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay; D008297:Male; D008589:Meningococcal Infections / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D010403:Penicillin Resistance; D011008:Pneumococcal Infections / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D011446:Prospective Studies
D000900:Anti-Bacterial Agents