title: Bacteremic pneumococcal community-acquired pneumonia in children less than 5 years of age in Italy.
abstract: BACKGROUND
  This study was designed to determine the proportion of bacteremic pneumococcal cases in a group of pediatric subjects with community-acquired pneumonia (CAP), the importance of the different serotypes and the impact of the currently available pneumococcal conjugate vaccines (PCVs).
  
  
  METHODS
  The study involved children who were ≤5 years with radiographically confirmed CAP admitted to hospital in Italy between September 2008 and March 2011. A diagnosis of laboratory-confirmed bacteremic pneumococcal CAP was made in the presence of a culture and/or real-time polymerase chain reaction (PCR) positive for Streptococcus pneumoniae.
  
  
  RESULTS
  A total of 510 children were included in the study. Pneumococcal CAP was diagnosed in 73 cases (14.3%): S. pneumoniae was identified by means of positive real-time PCR in 67 cases (91.8%), a positive blood culture in 1 (1.4%) and both in 5 (6.8%). Complicated pneumonia was observed significantly more often in the pneumococcal-positive cases (P=0.02) and empyema was the main complication (P=0.007). Serotype 19A was most frequently encountered (17 cases; 25.8%), followed by serotypes 14 (10 cases, 15.1%), 4 (5 cases, 7.6%) and 3 (4 cases, 6.1%). The theoretical coverage offered by the available PCVs was calculated to be 31% for PCV7, 37% for PCV10 and 71% for PCV13.
  
  
  CONCLUSIONS
  In Italy, bacteremic pneumococcal CAP accounts for a significant number of CAP cases in children who were ≤5 years, with serotypes 19A and 14 being the most frequent. This suggests that PCV13 is the best means of preventing pneumococcal CAP.
authors.affiliation: Department of Maternal and Pediatric Sciences, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Susanna
authors.initials: S
authors.lastname: Esposito
authors.forename: Anna
authors.initials: A
authors.lastname: Marchese
authors.forename: Alberto E
authors.initials: AE
authors.lastname: Tozzi
authors.forename: Giovanni A
authors.initials: GA
authors.lastname: Rossi
authors.forename: Liviana
authors.initials: L
authors.lastname: Da Dalt
authors.forename: Gianni
authors.initials: G
authors.lastname: Bona
authors.forename: Claudio
authors.initials: C
authors.lastname: Pelucchi
authors.forename: Gian Carlo
authors.initials: GC
authors.lastname: Schito
authors.forename: Nicola
authors.initials: N
authors.lastname: Principi
mesh_terms: D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology*; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000382:microbiology*; D005260:Female; D006801:Humans; D007223:Infant; D007558:Italy / Q000453:epidemiology; D008297:Male; D022242:Pneumococcal Vaccines / Q000276:immunology; D011018:Pneumonia, Pneumococcal / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology*; D015995:Prevalence; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000145:classification / Q000302:isolation & purification*
chemical_list: D022242:Pneumococcal Vaccines