Invasive Pneumococcal Infection in Urban Thai Children: A 10-Year Review†
Supichaya Netsawang MD*, Warunee Punpanich MD, PhD*, Vipa Treeratweeraphong BSc, MSc**, Tawee Chotpitayasunondh MD*
Affiliation : † This work was presented at the 1st National Pneumococcal Symposium, Bangkok, Thailand, November 26-27, 2008. *Department of Pediatrics, Queen Sirikit National Institute of Child Health College of Medicine, Rangsit University, Bangkok, Thailand **Department of Pathology, Queen Sirikit National Institute of Child Health College of Medicine, Rangsit University, Bangkok, Thailand
Objective : To determine the disease frequency, demographic characteristics, clinical manifestations, laboratory findings and
drug susceptibility patterns of childhood invasive pneumococcal infections in a hospital setting in Thailand.
Material and Method: A retrospective review was conducted of invasive pneumococcal infections among children aged <18
years from January 1, 1998 - December 31, 2007 at the Queen Sirikit National Institute of Child Health (QSNICH). Medical
records of case-patients were reviewed to collect information on demographics, clinical manifestations, laboratory findings,
and drug susceptibility patterns of infecting isolates.
Results : Among the 745,983 children receiving care at QSNICH during the study period, culture-proven invasive pneumococcal
infections were identified in 126 patients for an estimated incidence of 17 cases per 100,000 patients. Patient diagnoses
included bacteremia (59.4%), meningitis (29.3%), and pneumonia (11.3%). Of the 31 pneumococcal meningitis cases,
54.8% were caused by penicillin-nonsusceptible S. pneumoniae (PNSSP), while 25.3% of 75 non-meningitis cases were
PNSSP (records not available for the remaining 20 cases). Of 126 PNSSP, 8.2% were resistant to cefotaxime and 12.3% were
resistant to ceftriaxone. All of the isolates were susceptible to vancomycin. The case fatality rate was 12.3%; 23.1% of fatal
cases were associated with HIV infection. Outcomes did not differ significantly between patients infected with penicillin-
susceptible and non-susceptible pneumococcal strains.
Conclusion : The results of this hospital-based study indicate that the incidence of invasive pneumococcal infection in
QSNICH remains relatively low, but the case fatality rate is high, especially among those with HIV infection.
Keywords : Invasive pneumococcal infection, Children
