title: Host and microbiologic factors associated with mortality in Taiwanese children with invasive pneumococcal diseases, 2001 to 2006.
abstract: We concurrently evaluated host- and organism-related factors in determining the outcomes of 160 invasive pneumococcal diseases episodes in 158 Taiwanese children during 2001 and 2006. Most (138/160, 86.2%) episodes occurred at age less than 60 months, and an underlying condition was present in 35 (22.2%) cases. Common disease syndromes included complicated pneumonia (29.4%), uncomplicated pneumonia (29.4%), occult bacteremia (17.5%), and meningitis (14.4%). Mortality (13/160, 8.1%) was associated with age less than 24 months, underlying conditions, meningitis, cytopenia, intensive care, and penicillin MIC >or=2 microg/mL in univariate analysis. Pneumococcal serotypes, genotypes, origin of infections, and discordant therapy did not influence the outcome. Multivariate analysis determined the presence of underlying conditions (adjusted odds ratio [OR], 30.5; 95% confidence interval [CI], 4.8-193.1) and penicillin MIC >or=2 microg/mL (adjusted OR, 8.1; 95% CI, 1.4-47.3), which are the independent predictors for fatality. This finding highlighted the importance of immunization of disadvantaged children, targeting drug-resistant pneumococci.
authors.affiliation: Divisions of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Chih-Jung
authors.initials: CJ
authors.lastname: Chen
authors.forename: Chia-Ling
authors.initials: CL
authors.lastname: Lin
authors.forename: Yi-Ching
authors.initials: YC
authors.lastname: Chen
authors.forename: Chun-Wei
authors.initials: CW
authors.lastname: Wang
authors.forename: Cheng-Hsun
authors.initials: CH
authors.lastname: Chiu
authors.forename: Tzou-Yien
authors.initials: TY
authors.lastname: Lin
authors.forename: Yhu-Chering
authors.initials: YC
authors.lastname: Huang
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D024881:Drug Resistance, Bacterial; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008826:Microbial Sensitivity Tests; D015999:Multivariate Analysis; D011008:Pneumococcal Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000145:classification / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification; D013624:Taiwan
chemical_list: D000900:Anti-Bacterial Agents