Changing Epidemiology of Outpatient Bacteremia in 3- to 36-Month-Old Children After the Introduction of the Heptavalent-Conjugated Pneumococcal Vaccine

作者：Arnd M. Herz, Tara L. Greenhow, Jay Alcantara, John R. Hansen, Roger P. Baxter, Steve B. Black, Henry R. Shinefield · 发表于：The Pediatric Infectious Disease Journal · 年份：2006 · DOI：10.1097/01.inf.0000207485.39112.bf · 被引用次数：189 · 研究领域：Pneumonia and Respiratory Infections、Bacterial Infections and Vaccines、Neonatal and Maternal Infections

BACKGROUND: The introduction of routine vaccination with heptavalent conjugated pneumococcal vaccine has changed the overall incidence of bacteremia in children 3 months-3 years old. OBJECTIVE: To describe the changing incidence and etiology of bacteremia in previously healthy toddlers presenting to outpatient clinical settings. METHODS: Retrospective case series of all blood cultures obtained between September 1998 and August 2003 in Kaiser Permanente Northern California outpatient clinics and emergency departments from previously healthy children 3 months-3 years old. RESULTS: Implementation of routine vaccination with the conjugated pneumococcal vaccine resulted in an 84% reduction of Streptococcus pneumoniae bacteremia (1.3-0.2%) and a 67% reduction in overall bacteremia (1.6-0.7%) in the study population. The rate of blood culture isolation of contaminating organisms remained unchanged at 1.8%; therefore, by the end of the study, >70% of organisms identified in blood cultures were contaminants. During the 5 study years, total blood cultures drawn decreased by 35% in outpatient pediatric clinics but remained unchanged in emergency departments. By 2003, one-third of all pathogenic organisms isolated from blood cultures were Escherichia coli, one-third were non-vaccine serotype S. pneumoniae, the majority of the remaining one-third were Staphylococcus aureus, Salmonella spp., Neisseria meningitidis and Streptococcus pyogenes. In our population of children routinely immunize...