Streptococcus pneumoniae | American Academy of Pediatrics

Liset Olarte, MD, MSc*,†Mary Anne Jackson, MD*,†*Division of Pediatric Infectious Diseases, Department of Pediatrics, Children’s Mercy Hospital, Kansas City, MO†University of Missouri–Kansas City School of Medicine, Kansas City, MOAbbreviations: AOM: acute otitis media CDC: Centers for Disease Control and Prevention CSF: cerebrospinal fluid IDSA: Infectious Diseases Society of America IPD: invasive pneumococcal disease MDR: multidrug resistant MIC: minimal inhibitory concentration PBP: penicillin-binding protein PCR: polymerase chain reaction pPPNECK: 23 pneumococcal uncertainty range World Health Organisation

Education gap

The incidence of invasive pneumococcal disease has decreased significantly with the use of pneumococcal conjugate vaccines. Although 82% of children in the US aged 19 to 35 months have received 4 or more PCV vaccines, infections caused by vaccine serotypes still occur. However, in the United States, more than 70% of current invasive diseases are caused by non-vaccine serotypes, and there is an increased risk in healthy young children and children with underlying medical conditions for non-vaccine serotype pneumococcal infections.

Goals

After completing this article, readers should be able to:

Understand the changes in the epidemiology of pneumococcal infections following the introduction of pneumococcal conjugate vaccines.

Describe the clinical manifestations caused by Streptococcus pneumoniae and their empirical recommendations for antibiotic therapy.

Identify children with underlying medical conditions at high risk for invasive pneumococcal disease and provide adequate pneumococcal vaccination.

Most important points

Children under 5 years of age have a higher chance of nasopharyngeal pneumococcal colonization and are at increased risk of invasive pneumococcal infections.

Streptococcus pneumoniae remains one of the most common causes of bacterial middle ear infection, pneumonia and meningitis in pediatric patients outside the neonatal period.

Despite the widespread use of pneumococcal vaccines, vaccine serotypes still account for approximately 30% of invasive and non-invasive pneumococcal infections.

Children with specific medical conditions are at high risk for invasive pneumococcal disease due to vaccine serotypes not included in pneumococcal conjugate vaccines, and they require additional immunization with pneumococcal polysaccharide vaccine.

The interpretation of susceptibility to penicillin and third-generation cephalosporin for S-pneumoniae depends on the site of infection (meningitis versus non-meningitis).

Introduction

Streptococcus pneumoniae remains the most common cause of childhood vaccine death worldwide. Pneumococcal infections were responsible for an estimated 318,000 deaths (uncertainty range [UR], 207,000-395,000) among children under 5 years of age worldwide in 2015. (1) Deaths from pneumococcal pneumonia accounted for 81% of…

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