title: The aetiology of paediatric bloodstream infections changes after pneumococcal vaccination and group B streptococcus prophylaxis.
abstract: OBJECTIVE
  This study explored the incidence and aetiology of bloodstream infections after patients received the pneumococcal conjugate vaccination and a risk-based intrapartum antibiotic prophylaxis against early onset sepsis caused by group B streptococcus. We also monitored clinically relevant antimicrobial resistance.
  
  
  METHODS
  We studied 3986 positive blood cultures from children up to 17 years of age at a paediatric hospital in Stockholm, Sweden, using data from medical records before and after the initiatives, to reduce early onset sepsis, were introduced in 2007 and 2008.
  
  
  RESULTS
  Bloodstream infections caused by Streptococcus pneumoniae declined by 42% overall (5.6 to 3.2/100 000) and by 62% in previously healthy children under 36 months of age (24.2 to 9.2/100 000). Early onset sepsis caused by group B streptococcus declined by 60% (0.5 to 0.2/1000 live born children). Bacterial meningitis caused by these bacteria decreased by 70%. Staphylococcus aureus and various Gram-negative bacteria became the dominant pathogens, in both previously healthy children and those with underlying disease. Overall, antimicrobial resistance remained low between the two 5-year study periods.
  
  
  CONCLUSIONS
  Pneumococcal conjugate vaccination and risk-based intrapartum antibiotic prophylaxis against group B streptococcus effectively decreased the incidence of bloodstream infections. Empirical antibiotic therapy should target Staphylococcus aureus in both community and hospital-acquired invasive bacterial infections.
authors.affiliation: Paediatric Infectious Diseases Unit, Paediatric Emergency Department, Astrid Lindgren's Children Hospital, Stockholm, Sweden.|Clinical Paediatric Unit, Department of Woman and Child Health, Astrid Lindgren Children's Hospital, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Joachim
authors.initials: J
authors.lastname: Luthander
authors.affiliation: Paediatric Infectious Diseases Unit, Paediatric Emergency Department, Astrid Lindgren's Children Hospital, Stockholm, Sweden.
authors.forename: Rutger
authors.initials: R
authors.lastname: Bennet
authors.affiliation: Clinical Microbiology, Karolinska University Hospital and Department of Microbiology, Tumour and Cell Biology (MTC), Karolinska Institutet, Stockholm, Sweden.
authors.forename: Christian G
authors.initials: CG
authors.lastname: Giske
authors.affiliation: Paediatric Infectious Diseases Unit, Paediatric Emergency Department, Astrid Lindgren's Children Hospital, Stockholm, Sweden.|Clinical Paediatric Unit, Department of Woman and Child Health, Astrid Lindgren Children's Hospital, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Nilsson
authors.affiliation: Paediatric Infectious Diseases Unit, Paediatric Emergency Department, Astrid Lindgren's Children Hospital, Stockholm, Sweden.
authors.forename: Margareta
authors.initials: M
authors.lastname: Eriksson
mesh_terms: D000293:Adolescent; D019072:Antibiotic Prophylaxis; D016470:Bacteremia / Q000382:microbiology* / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000382:microbiology* / Q000517:prevention & control*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D022242:Pneumococcal Vaccines; D012189:Retrospective Studies; D013211:Staphylococcus aureus; D013292:Streptococcus agalactiae; D013296:Streptococcus pneumoniae; D013548:Sweden
chemical_list: D022242:Pneumococcal Vaccines
keywords: Aetiology; Antibiotic resistance; Bloodstream infections; Group B streptococcus; Pneumococcus