Complicated pneumococcal pneumonia in children at a university hospital in São Paulo (Brazil)

Background: Increasing prevalence of pleural empyema complicating community acquired pneumonia(CAP) is reported worldwide. Pleural empyema is reported in up to 28% of children hospitalized with CAP. In Brazil the 10-valent pneumococcal conjugate vaccine (PCV-10) was introduced in the National Immunization Program in April 2010.\ud Methods: From January 2003 to December 2011, a retrospective study of hospitalized children with a diagnosis of pneumococcal pneumonia was conducted at the Hospital Universitário da USP. Criteria for inclusion were: over 29 days and under 15 years,\ud radiological and clinical diagnosis of pneumonia, and isolation of Streptococcus pneumoniae in blood cultures and/or pleural effusion. Results: The study included 152 children. Eighty-six were male (56.6%), median age was 23 months (53.3% ≤24 months). The median length of hospital stay was 7.5 days. The most common serotypes isolated were 14 (40.2%), 5 (13.6%), 1 (12.9%), 6B (6.1%) and 19A (4.5%). Ninety (59.2%) of them had complications. Of the children complicated, empyema occurred in 51.1% and uncomplicated pleural effusion in 37.8%. Other\ud complications were: septicemia requiring vasoactive drugs (24.4%), pneumatocele (15.6%), pneumothorax (12.2%), atelectasis (10%), necrotizing pneumonia (5.6%) and lung abscess (5.6%). The median age of children with empyema was 32.5 months. The median length of hospital stay for cases of empyema was 15 days. The most common serotypes in empyema were 14 (35%), 5 (27.5%), 1 (12.5%), and 19A (7.5%). The coverage for pneumococcal pneumonia in 10-valent and 13-valent conjugate vaccines was 85.6% and 96.2% respectively and for empyema was 90% and 97.5%. There was a trend towards increased complications, especially empyema during the years of study. Three children died. Conclusions: The complications often occurred in older children and the most frequent were empyema and pleural effusion\ud uncomplicated. The coverage for complicated pneumonia by PCV-10 and PCV-13 were excellent.Apresentado no 11th International Congress on Pediatric Pulmonology, June 30 - July 2, 2012, Bangkok, Thailand