Changing Epidemiology and Predisposing Factors for Invasive Pneumococcal Disease at Two Australian Tertiary Hospitals

Pediatr Infect Dis J. 2020 Jan;39(1):1-6. doi: 10.1097/INF.0000000000002489.


Background: Invasive pneumococcal disease (IPD) is associated with significant morbidity and mortality in children. Universal pneumococcal conjugate vaccination has changed the epidemiology of IPD. In vaccinated children, IPD can be a marker of an underlying immunodeficiency.

Methods: This is a retrospective audit of children younger than 18 years with IPD admitted to 2 tertiary pediatric hospitals in Australia between 2011 and 2017. Data on predisposing conditions, immunologic evaluation, pneumococcal serotype, antibiotic susceptibility and treatment were collected.

Results: During the 7-year period, there were 131 presentations with IPD in 127 children; 3 children had recurrent IPD. Patients presented with sepsis (41%), empyema (29%), meningitis (18%), mastoiditis (12%), pneumonia (10%) and septic arthritis (4%). In 19 (15%) presentations, risk factors for IPD were present, including malignancy, hematologic disorder, chronic liver disease, chronic kidney disease and cochlear implant. Pneumococcal serotypes were determined in 78/131 (60%) of presentations: the most frequent serotypes were 19A (19%), 3 (13%), 7F (10%) and 19F (8%) and non-vaccine serotypes 22F (8%), 35B (6%), 15A (4%) and 38 (4%). Overall, 11% of isolates were non-susceptible to ceftriaxone. Only 36 patients (32%) had an immunologic evaluation, and 4 patients had proven or probable immunodeficiency.

Conclusion: Although pneumococcal conjugate vaccine serotypes 19A, 3, 19F and 7F remain frequent causes of IPD, non-vaccine serotypes are emerging. Our data support vancomycin treatment for children with pneumococcal meningitis given 11% of our isolates were not susceptible to ceftriaxone. It is important to consider underlying conditions predisposing to IPD in a population with high rates of pneumococcal vaccination.

MeSH terms

  • Anti-Bacterial Agents / pharmacology
  • Anti-Bacterial Agents / therapeutic use
  • Australia / epidemiology
  • Cross Infection / drug therapy
  • Cross Infection / epidemiology*
  • Cross Infection / etiology*
  • Disease Susceptibility
  • Drug Resistance, Bacterial
  • Female
  • Humans
  • Male
  • Microbial Sensitivity Tests
  • Pneumococcal Infections / drug therapy
  • Pneumococcal Infections / epidemiology*
  • Pneumococcal Infections / etiology*
  • Public Health Surveillance
  • Retrospective Studies
  • Serogroup
  • Streptococcus pneumoniae* / classification
  • Streptococcus pneumoniae* / drug effects
  • Streptococcus pneumoniae* / genetics
  • Tertiary Care Centers*


  • Anti-Bacterial Agents