title: Clinical features and outcomes of invasive pneumococcal disease in a pediatric intensive care unit.
abstract: BACKGROUND
  Invasive pneumococcal disease (IPD) results in high morbidity and mortality globally each year, although it is a vaccine-preventable disease. This study aimed to characterize the clinical features of IPD in a pediatric intensive care unit (PICU) in Taiwan. The seven-valent pneumococcal conjugate vaccine (PCV7) was introduced in the private sector in October 2005. The estimated coverage rate of PCV7 vaccination in 2010 was 45.5% among children <5 years of age.
  
  
  METHODS
  We conducted a retrospective study at a single center in northern Taiwan for invasive pneumococcal disease in a PICU from 2009 to 2013. Demographic characteristics, clinical courses, serotype, antibiotic susceptibility, and outcomes were analyzed.
  
  
  RESULTS
  Over the 5-year study period, 2167 patients were admitted to the PICU; 48 (2.2%) had IPD. There were 29 female and 19 male patients. Their mean age was 3.7 years (range 0.7-12.5 years, with the peak age at 2-5 years; n = 30, 63%). Pneumonia was the most frequent type (n = 38, 79%), followed by meningitis (n = 10, 21%). In total, three patients died, all within 72 h after admission; the final diagnoses were all meningitis. Thirty-four children with pneumonia received chest tube insertion for pleural effusion drainage. Of them, 22 (65%) finally still underwent video-assisted thoracoscopic surgery. Eight (17%) children had hemolytic uremic syndrome, and seven of them underwent hemodialysis. In total, 37 serotypes were detected; 95% were covered by PCV13. Serotype 19A was most common (54%) overall; however, in those with meningitis, serotype 19 F was most common.
  
  
  CONCLUSIONS
  Meningitis is the most severe type of invasive pneumococcal disease in our pediatric intensive care unit. It may progress rapidly even when subjects are given antibiotics promptly. The most common serotype in meningitis is 19 F, which is vaccine preventable. Thus, universal mass pneumococcal vaccination is still needed.
authors.affiliation: Department of Pediatrics, Chang Gung Memorial Hospital, Keelung, Taiwan. hsiaosris@gmail.com.|Chang Gung University College of Medicine, Taoyuan, Taiwan. hsiaosris@gmail.com.
authors.forename: Hsiang-Ju
authors.initials: HJ
authors.lastname: Hsiao
authors.affiliation: Chang Gung University College of Medicine, Taoyuan, Taiwan. wu0722@cgmh.org.tw.|Division of General Pediatrics, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou, Taiwan. wu0722@cgmh.org.tw.
authors.forename: Chang-Teng
authors.initials: CT
authors.lastname: Wu
authors.affiliation: Chang Gung University College of Medicine, Taoyuan, Taiwan. long@cgmh.org.tw.|Division of Asthma, Allergy, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou, Taiwan. long@cgmh.org.tw.
authors.forename: Jing-Long
authors.initials: JL
authors.lastname: Huang
authors.affiliation: Chang Gung University College of Medicine, Taoyuan, Taiwan. chchiu@cgmh.org.tw.|Molecular Infectious Disease Research Center, Division of Pediatric Infection, Chang Gung Memorial Hospital, Linkou, Taiwan. chchiu@cgmh.org.tw.
authors.forename: Cheng-Hsun
authors.initials: CH
authors.lastname: Chiu
authors.affiliation: Chang Gung University College of Medicine, Taoyuan, Taiwan. ychuang@cgmh.org.tw.|Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou, Taiwan. ychuang@cgmh.org.tw.
authors.forename: Yhu-Chering
authors.initials: YC
authors.lastname: Huang
authors.affiliation: Chang Gung University College of Medicine, Taoyuan, Taiwan. lin0227@cgmh.org.tw.|Division of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou, Taiwan. lin0227@cgmh.org.tw.
authors.forename: Jainn-Jim
authors.initials: JJ
authors.lastname: Lin
authors.affiliation: Department of Pediatrics, Chang Gung Memorial Hospital, Keelung, Taiwan. hianne@cgmh.org.tw.|Chang Gung University College of Medicine, Taoyuan, Taiwan. hianne@cgmh.org.tw.
authors.forename: I-Anne
authors.initials: IA
authors.lastname: Huang
authors.affiliation: Chang Gung University College of Medicine, Taoyuan, Taiwan. ai3333@cgmh.org.tw.|Division of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou, Taiwan. ai3333@cgmh.org.tw.
authors.forename: Oi-Wa
authors.initials: OW
authors.lastname: Chan
authors.affiliation: Chang Gung University College of Medicine, Taoyuan, Taiwan. chouijun@gmail.com.|Division of General Pediatrics, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou, Taiwan. chouijun@gmail.com.
authors.forename: I-Jun
authors.initials: IJ
authors.lastname: Chou
authors.affiliation: Chang Gung University College of Medicine, Taoyuan, Taiwan. shsia@cgmh.org.tw.|Division of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou, Taiwan. shsia@cgmh.org.tw.
authors.forename: Shao-Hsuan
authors.initials: SH
authors.lastname: Hsia
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D011008:Pneumococcal Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control; D022242:Pneumococcal Vaccines; D012189:Retrospective Studies; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000145:classification; D013624:Taiwan / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D022242:Pneumococcal Vaccines