Invasive pneumococcal infection in urban Thai children: a 10-year review.

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% offatal 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.