Invasive Pneumococcal Disease in Children Under Five Years in a Tertiary Care Center, Saudi Arabia

Background: The problem of invasive pneumococcal disease (IPD) has been one of the leading health issues causing morbidity and mortality in young children, even when pneumococcal conjugate vaccines have been used widely. Limited data exists on clinical features, vaccination, and antimicrobial susceptibility, and outcomes of IPD among Saudi Arabian children. Objective: To characterize the epidemiology, clinical manifestation, vaccination history, and antimicrobial resistance trends, as well as the outcomes of invasive Streptococcus pneumoniae infection among children under the age of five years in a tertiary care unit in Saudi Arabia. Methods: The study was a retrospective observational one, which was carried out in the Prince Sultan Military Medical City, where it reviewed cases of invasive Streptococcus pneumoniae infection in children aged 0-5 years, which were confirmed by microbiology between January 2009 and January 2019. Medical records were analyzed to obtain demographic, clinical, radiological, laboratory, microbiological, vaccination, treatment, and outcome information. The IBM SPSS version 26 was used to perform descriptive statistical analysis. Results: Sixty-seven children who were diagnosed with invasive pneumococcal infection were detected. Males were 55.2 percent of the cases, and the highest age of infection was two years. In 73.1 percent of patients, the blood cultures were positive. The presenting symptom of fever was the most frequent (65.7%); 43.3% and 44.8% of children did not have respiratory or gastrointestinal symptoms, respectively. In 34.3% of cases, neurological manifestations were observed. Those with pneumococcal vaccination data were 43 patients, and of them, 37.2 were unvaccinated during the time of infection. Ceftriaxone was the most susceptible to antimicrobials (82.1%), whereas penicillin was found to be less susceptible in a significant percentage of the isolates. There was an in-hospital mortality of 19.4% patients.