{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T17:00:31Z","timestamp":1761238831747,"version":"3.41.2"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2020,12,15]],"date-time":"2020-12-15T00:00:00Z","timestamp":1607990400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:p><jats:bold>Introduction:<\/jats:bold> After the introduction of pneumococcal conjugate vaccines, community-acquired pneumonia (CAP) caused by <jats:italic>Streptococcus pneumoniae<\/jats:italic> has decreased whereas <jats:italic>Staphylococcus aureus<\/jats:italic> and <jats:italic>Streptococcus pyogenes<\/jats:italic> could be increasing. These bacteria have been associated with high rates of complications.<\/jats:p><jats:p><jats:bold>Aims:<\/jats:bold> (1) To describe the characteristics of pediatric bacterial CAP requiring hospitalization. (2) To compare outcomes according to causative microorganisms. (3) To analyze changes in bacterial CAP rate and etiology over time.<\/jats:p><jats:p><jats:bold>Patients and Methods:<\/jats:bold> Retrospective single-center study of inpatients aged 1 month-16 years with culture-confirmed bacterial CAP in 2010-2018 in Madrid, Spain.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> We included 64 cases (42 <jats:italic>S. pneumoniae<\/jats:italic>, 13 <jats:italic>S. pyogenes<\/jats:italic> and 9 <jats:italic>S. aureus<\/jats:italic>). Culture-confirmed CAP represented 1.48-2.33\/1,000 all-cause pediatric hospital admissions, and its rate did not vary over time. However, there was a significant decrease in pneumococcal CAP in the last 3 years of the study (78% of CAP in 2010\u20132015 vs. 48% in 2016-18, <jats:italic>p<\/jats:italic> = 0.017). Median hospital stay was 10.5 days (interquartile range 5-19.5), 38 patients (59%) developed complications and 28 (44%) were admitted to the intensive care unit. Outcomes were similar among children with <jats:italic>S. pneumoniae<\/jats:italic> and <jats:italic>S. aureus<\/jats:italic> CAP, whereas <jats:italic>S. pyogenes<\/jats:italic> was associated with a higher risk for complications (OR 8 [95%CI 1.1-57.2]) and ICU admission (OR 7.1 [95%CI 1.7-29.1]) compared with pneumococcal CAP.<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> In a setting with high PCV coverage, culture-confirmed bacterial CAP did not decrease over time and there was a relative increase of <jats:italic>S. pyogenes<\/jats:italic> and <jats:italic>S. aureus<\/jats:italic>. Children with CAP caused by <jats:italic>S. pyogenes<\/jats:italic> were more likely to develop complications.<\/jats:p>","DOI":"10.3389\/fped.2020.576519","type":"journal-article","created":{"date-parts":[[2021,1,10]],"date-time":"2021-01-10T19:00:02Z","timestamp":1610305202000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":9,"title":["Outcome of Severe Bacterial Pneumonia in the Era of Pneumococcal Vaccination"],"prefix":"10.3389","volume":"8","author":[{"given":"Teresa","family":"del Rosal","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mar\u00eda Bel\u00e9n","family":"Caminoa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alba","family":"Gonz\u00e1lez-Guerrero","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Iker","family":"Falces-Romero","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mar\u00eda Pilar","family":"Romero-G\u00f3mez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fernando","family":"Baquero-Artigao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tal\u00eda","family":"Sainz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana","family":"M\u00e9ndez-Echevarr\u00eda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luis","family":"Escosa-Garc\u00eda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francisco Javier","family":"Aracil","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristina","family":"Calvo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2020,12,15]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1405","DOI":"10.1016\/S0140-6736(13)60222-6","article-title":"Global burden of childhood pneumonia and diarrhoea","volume":"381","author":"Walker","year":"2013","journal-title":"Lancet."},{"key":"B2","doi-asserted-by":"publisher","first-page":"835","DOI":"10.1056\/NEJMoa1405870","article-title":"Community-acquired pneumonia requiring hospitalization among U","volume":"372","author":"Jain","year":"2015","journal-title":"N Engl J Med."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1177\/000992280504400101","article-title":"Overcoming current obstacles in the management of bacterial community-acquired pneumonia in ambulatory children","volume":"44","author":"Pelton","year":"2005","journal-title":"Clin Pediatr."},{"key":"B4","doi-asserted-by":"publisher","first-page":"e320","DOI":"10.1097\/INF.0000000000002474","article-title":"Increasing rates of pediatric empyema and disease severity with predominance of serotype 3 s pneumonia: An Australian Single-center, Retrospective Cohort 2011 to 2018","volume":"38","author":"Haggie","year":"2019","journal-title":"Pediatr Infect Dis J."},{"key":"B5","doi-asserted-by":"publisher","first-page":"857","DOI":"10.1016\/j.cmi.2018.10.020","article-title":"Changes in the incidence and bacterial aetiology of paediatric parapneumonic pleural effusions\/empyema in germany, 2010-2017: a nationwide surveillance study","volume":"25","author":"Liese","year":"2019","journal-title":"Clin Microbiol Infect."},{"key":"B6","doi-asserted-by":"publisher","first-page":"731","DOI":"10.1136\/archdischild-2015-309831","article-title":"When should clinicians suspect group a streptococcus empyema in children? A multicentre case-control study in French tertiary care centres","volume":"101","author":"Bellulo","year":"2016","journal-title":"Arch Dis Child."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1008","DOI":"10.1097\/01.inf.0000243198.63255.c1","article-title":"A comparison of group a Streptococcus versus Streptococcus pneumoniae pneumonia","volume":"25","author":"Al-Kaabi","year":"2006","journal-title":"Pediatr Infect Dis J"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1177","DOI":"10.1007\/s10096-016-2651-7","article-title":"Community-associated Staphylococcus aureus pneumonia among greek children: epidemiology, molecular characteristics, treatment, and outcome","volume":"35","author":"Doudoulakakis","year":"2016","journal-title":"Eur J Clin Microbiol Infect Dis."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1179","DOI":"10.1016\/S0140-6736(07)60564-9","article-title":"Decline in pneumonia admissions after routine childhood immunisation with pneumococcal conjugate vaccine in the USA: a time-series analysis","volume":"369","author":"Grijalva","year":"2007","journal-title":"Lancet."},{"key":"B10","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1056\/NEJMoa1209165","article-title":"U.S. hospitalizations for pneumonia after a decade of pneumococcal vaccination","volume":"369","author":"Griffin","year":"2013","journal-title":"N Engl J Med."},{"key":"B11","doi-asserted-by":"publisher","first-page":"362","DOI":"10.1001\/jamapediatrics.2018.5273","article-title":"Long-term association of 13-Valent pneumococcal conjugate vaccine implementation with rates of community-acquired pneumonia in children","volume":"173","author":"Ouldali","year":"2019","journal-title":"JAMA Pediatr."},{"key":"B12","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1016\/j.idc.2017.11.002","article-title":"Pediatric community-acquired pneumonia in the United States","volume":"32","author":"Katz","year":"2018","journal-title":"Infect Dis Clin N Am."},{"key":"B13","doi-asserted-by":"publisher","first-page":"2704","DOI":"10.1016\/j.vaccine.2019.04.012","article-title":"Significant impact of pneumococcal conjugate vaccination on pediatric parapneumonic effusion: Italy 2006-2018","volume":"37","author":"Azzari","year":"2019","journal-title":"Vaccine."},{"key":"B14","doi-asserted-by":"publisher","first-page":"474","DOI":"10.1093\/jpids\/piy103","article-title":"Change in bacterial causes of community-acquired parapneumonic effusion and pleural empyema in children 6 years after 13-valent pneumococcal conjugate vaccine implementation","volume":"8","author":"Madhi","year":"2019","journal-title":"J Pediatric Infect Dis Soc."},{"key":"B15","doi-asserted-by":"publisher","first-page":"e20183090","DOI":"10.1542\/peds.2018-3090","article-title":"Prevalence, risk factors, and outcomes of bacteremic pneumonia in children","volume":"144","author":"Fritz","year":"2019","journal-title":"Pediatrics."},{"key":"B16","doi-asserted-by":"publisher","first-page":"179","DOI":"10.2807\/esm.10.09.00563-en","article-title":"The epidemiology of severe Streptococcus pyogenes associated disease in Europe","volume":"10","author":"Lamagni","year":"2005","journal-title":"Euro Surveill."},{"key":"B17","doi-asserted-by":"publisher","first-page":"1589","DOI":"10.1007\/s00431-012-1694-8","article-title":"Current insights in invasive group a streptococcal infections in pediatrics","volume":"171","author":"Filleron","year":"2012","journal-title":"Eur J Pediatr."},{"key":"B18","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1097\/INF.0000000000000945","article-title":"Invasive group a Streptococcal infections in children: a Nationwide survey in finland","volume":"35","author":"Tapiainen","year":"2016","journal-title":"Pediatr Infect Dis J."},{"key":"B19","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1016\/j.anpedi.2018.12.017","article-title":"[Invasive disease due to streptococcus pyogenes: changes in incidence and prognostic factors]","volume":"91","author":"Su\u00e1rez-Arrabal","year":"2019","journal-title":"An Pediatr."},{"key":"B20","doi-asserted-by":"publisher","first-page":"952","DOI":"10.1097\/INF.0000000000001940","article-title":"Blood culture and pleural fluid culture yields in pediatric empyema patients: a Retrospective review, 1996-2016","volume":"37","author":"Stankey","year":"2018","journal-title":"Pediatr Infect Dis J."},{"key":"B21","doi-asserted-by":"publisher","first-page":"848","DOI":"10.12788\/jhm.3093","article-title":"Prevalence of staphylococcus aureus and use of antistaphylococcal therapy in children hospitalized with pneumonia","volume":"13","author":"Frush","year":"2018","journal-title":"J Hosp Med."},{"key":"B22","doi-asserted-by":"publisher","first-page":"300","DOI":"10.1093\/cid\/ciw300","article-title":"Staphylococcus aureus community-acquired pneumonia: prevalence, clinical characteristics, and outcomes","volume":"63","author":"Self","year":"2016","journal-title":"Clin Infect Dis."},{"key":"B23","doi-asserted-by":"publisher","first-page":"701","DOI":"10.1542\/peds.113.4.701","article-title":"Epidemiology and clinical characteristics of community-acquired pneumonia in hospitalized children","volume":"113","author":"Michelow","year":"2004","journal-title":"Pediatrics."},{"key":"B24","doi-asserted-by":"publisher","first-page":"1346","DOI":"10.1086\/521626","article-title":"Incidence of pneumococcal disease due to non-pneumococcal conjugate vaccine (PCV7) serotypes in the United States during the era of widespread pCV7 vaccination, 1998-2004","volume":"196","author":"Hicks","year":"2007","journal-title":"J Infect Dis."},{"key":"B25","doi-asserted-by":"publisher","first-page":"2200","DOI":"10.1016\/j.vaccine.2019.03.015","article-title":"Impact of 13-valent pneumococcal conjugate vaccination on invasive pneumococcal disease in children under 15 years old in Madrid, Spain, 2007 to 2016: The HERACLES clinical surveillance study","volume":"37","author":"Picazo","year":"2019","journal-title":"Vaccine."},{"key":"B26","doi-asserted-by":"publisher","first-page":"1699","DOI":"10.1093\/cid\/cix115","article-title":"Pneumococcal pneumonia requiring hospitalization in US children in the 13-valent pneumococcal conjugate vaccine era","volume":"64","author":"Olarte","year":"2017","journal-title":"Clin Infect Dis."},{"key":"B27","doi-asserted-by":"publisher","first-page":"e0177113","DOI":"10.1371\/journal.pone.0177113","article-title":"Serotype distribution of Streptococcus pneumoniae causing invasive disease in children in the post-PCV era: a systematic review and meta-analysis","volume":"12","author":"Balsells","year":"2017","journal-title":"PLoS ONE."},{"key":"B28","doi-asserted-by":"publisher","first-page":"ofw020","DOI":"10.1093\/ofid\/ofw020","article-title":"Insight into resistance phenotypes of emergent non 13-valent pneumococcal conjugate vaccine type pneumococci isolated from invasive disease after 13-valent pneumococcal conjugate vaccine implementation in France","volume":"3","author":"Janoir","year":"2016","journal-title":"Open Forum Infect Dis."},{"key":"B29","doi-asserted-by":"publisher","first-page":"5481","DOI":"10.1038\/s41598-019-41983-8","article-title":"Molecular characterization and epidemiology of Streptococcus pneumoniae serotype 24F in Denmark","volume":"9","author":"Kavalari","year":"2019","journal-title":"Sci Rep."},{"key":"B30","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1155\/2014\/757963","article-title":"Real-time polymerase chain reaction for microbiological diagnosis of parapneumonic effusions in Canadian children","volume":"25","author":"Pernica","year":"2014","journal-title":"Can J Infect Dis Med Microbiol."},{"key":"B31","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1097\/INF.0b013e3182002d14","article-title":"Molecular analysis improves pathogen identification and epidemiologic study of pediatric parapneumonic empyema","volume":"30","author":"Blaschke","year":"2011","journal-title":"Pediatr Infect Dis J."}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2020.576519\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,1,10]],"date-time":"2021-01-10T19:00:06Z","timestamp":1610305206000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2020.576519\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,12,15]]},"references-count":31,"alternative-id":["10.3389\/fped.2020.576519"],"URL":"https:\/\/doi.org\/10.3389\/fped.2020.576519","relation":{},"ISSN":["2296-2360"],"issn-type":[{"type":"electronic","value":"2296-2360"}],"subject":[],"published":{"date-parts":[[2020,12,15]]},"article-number":"576519"}}