The aetiology of paediatric pneumonia and empyema at monash children's hospital and factors associated with complicated disease, in the pneumococcal conjugate vaccine-13 era.282.

Abstract

Introduction: Bacterial pneumonia is most commonly caused by Streptococcus pneumoniae. Following the introduction of the first pneumococcal conjugate vaccine, PCV7, a fall in the rate of paediatric pneumonia was observed however empyema rates increased with the emergence of non-vaccine serotypes. To address this, PCV13 was introduced in 2011. This study aims to identify the bacterial aetiology of pneumonia and empyema at Monash Children's Hospital and the prevalence of PCV13 serotypes. Furthermore, factors associated with the development of empyema were identified. Method(s): 63 pneumonia and 44 empyema patients were prospectively recruited between November 2015 - July 2018, as part of the TESTOV-Pneumo study. Nasopharyngeal swabs, blood and pleural fluid were tested for bacterial aetiologies using Polymerase Chain Reaction and cultures. S. pneumoniae positive samples were serotyped. Separate nasal swabs were analysed for viruses. Demographic and clinical factors were compared between the groups. Result(s): Streptococcus pneumoniae was the most commonly identified pathogen in both the pneumonia (22.2%) and empyema (68.2%) groups. S. aureus was identified in both pneumonia (20.0%) and empyema (15.9%) and S. pyogenes was found in 22.7% of empyema cases. The prevalence of PCV13 serotypes were: 1(0%), 19A(2.3%) and 3(41.9%). Viral co-infection was more common in empyema (36.4% vs 17.5%; P = 0.047). C-reactive Protein (CRP) on admission over 120mg/L (OR 8.45; 95% CI 2.1- 33.4) and use of ibuprofen during hospital stay (OR 9.81; 95% CI 1.2-76.7) were associated with development of empyema. Conclusion(s): In the PCV13 era, the rate of pneumonia and empyema caused by serotype 3 remains high and S. pyogenes was identified as a cause of complicated disease. Elevated CRP >120 mg/L on admission and use of ibuprofen during hospital stay were associated with the development of empyema.