Authorship and contributorship
Cardiopulmonary morbidity of streptococcal infections in a PICU
Article first published online: 19 FEB 2014
© 2014 John Wiley & Sons Ltd
The Clinical Respiratory Journal
How to Cite
Hon, K.-L. E., Fu, A., Leung, T. F., Poon, T. C. W., Cheung, W. H., Fong, C. Y., Ho, Y. T. C., Lee, T. Y. J., Ng, T. M., Yu, W. L., Cheung, K. L., Lee, V. and Ip, M. (2014), Cardiopulmonary morbidity of streptococcal infections in a PICU. The Clinical Respiratory Journal. doi: 10.1111/crj.12103
Hon K-LE is the principal author. Fu A and Leung TF are co-authors in writing the manuscript. Poon TC is responsible for the statistical analyses. Cheung WH, Fong CY, Ho YT, Lee TY, Ng TM and Yu WL are responsible for record review, data collection and verification. Cheung KL is the consultant pediatric intensivist in the care of the PICU patients. Lee V is the pharmacist and Ip M the microbiologist who provided inputs on the pneumococcal, antimicrobial and immunization aspects of the writing.
Ethics approval for this review was obtained from the Clinical Research Ethics Committee of our university.
Conflict of interest
K-LE Hon has received travel and conference sponsorship from Pfizer (Wyeth). MI has received funds for sponsored study and consultancy work for Pfizer (Wyeth), and participated in studies funded by Novartis, and Janssen Pharmaceuticals.
- Article first published online: 19 FEB 2014
- Accepted manuscript online: 9 JAN 2014 09:29PM EST
- Manuscript Accepted: 4 JAN 2014
- Manuscript Revised: 20 DEC 2013
- Manuscript Received: 21 JUL 2013
- agalactiae ;
- hemolytic uremic syndrome ;
- immunizations ;
- pleural effusion ;
- pneumococcus ;
- pyogenes ;
- serotypes ;
The streptococci are important bacteria that cause serious childhood infections. We investigated cardiopulmonary morbidity associated with streptococcal infection and pediatric intensive care unit (PICU) admission.
A retrospective study between 2002 and 2013 of all children with a laboratory isolation of streptococcus.
There were 40 (2.3%) PICU patients with streptococcal isolations including Streptococcus pyogenes (Group A streptococcus, GAS, n = 7), Streptococcus agalactiae (Group B streptococcus, GBS, n = 5), Streptococcus pneumoniae (SP, n = 20), alpha-hemolytic (n = 4), beta-hemolytic (n = 2) and gama-hemolytic (n = 2) streptococci. Comparing among GAS, GBS and SP, respiratory isolates were more likely positive for GAS or SP (P = 0.033), whereas cerebrospinal fluid was more likely positive for GBS (P = 0.002). All GAS and GBS, and the majority of SP (90%) were sensitive to penicillin. All SP specimens were sensitive to cefotaxime and vancomycin. These infections were associated with high PICU mortality of 43%, 20% and 25%, respectively. Isolation of streptococci was associated with a 30% mortality and high rates of need for mechanical ventilatory and inotropic supports. Patients with GAS, SP or any streptococcal isolation had relative risks [95% confidence interval (CI), P value] of PICU deaths of 7.5 (CI 3.1–18.1, P < 0.0001), 4.5 (CI 2.0–9.8, P < 0.0002) and 5.7 (CI 3.4–9.5, P < 0.0001), respectively. In SP, older children had significantly higher prevalence of premorbid conditions such as malignancy, mental retardation/cerebral palsy ± seizure disorders, chromosomal or genetic disorders (P = 0.003) than children <5 years of age. Serotypes were available for some of these specimens that included 19A, 6B, 3 and 6C. There were four SP deaths with multiorgan system failure and hemolytic uremic syndrome (two 19A and two serotype 3).
Severe streptococcal infections are associated with significant morbidity and mortality despite treatment with systemic antibiotics and intensive care unit support. GAS and SP affect the lungs of children, whereas GBS more likely causes meningitis in infants. The expanded coverage of newer polyvalent pneumococcal vaccines can probably prevent infections by serotypes 19A, 19F, 6B and 3.