Invasive Pneumococcal Disease in Argentine Children After Widespread PCV13 Use: Burden, Potential PCV20 Coverage and Mortality Risk Factors Across Three Years of Surveillance

作者：Gentile Á, Bakir J, López Papucci S, Ensinck G, Firpo MV, López O, López L, Juárez X, Cancellara AD, Pejito MN, Tapponnier G, Tinnirello A · 发表于：The Pediatric infectious disease journal · 年份：2026 · DOI：10.1097/INF.0000000000005299

BACKGROUND: In Argentina, widespread 13-valent pneumococcal conjugate vaccine (PCV13) use has reshaped pediatric invasive pneumococcal disease (IPD) epidemiology, with ongoing serotype shifts. We assessed IPD burden, clinical and microbiological features, PCV20 coverage, and mortality risk factors. METHODS: Multicenter prospective observational study based on active surveillance, conducted in 6 pediatric sentinel hospitals (October 2022-September 2025). Children ≤15 years hospitalized with laboratory-confirmed IPD were included. Hospitalization rates per 10,000 discharges were calculated with 95% confidence intervals (CIs). Mortality risk factors were assessed using logistic regression. RESULTS: Among 136,018 hospital discharges, 218 IPD cases were identified (16.0 per 10,000; 95% CI, 14.0-18.3; 0.16% of hospitalizations), with the highest rates in children aged 2-4 years (26.5 per 10,000; 95% CI: 20.6-33.5). Half (45.9%) had underlying conditions. Pneumonia predominated (65.6%), often complicated by pleural effusion/empyema or necrotizing disease, and 18.9% required mechanical ventilation; meningitis occurred in 14.7%. Among 119 serotyped isolates, 30.3% were PCV13, 21.0% additional PCV20 and 48.7% non-PCV20 serotypes, yielding an estimated PCV20 coverage of 51.3%. All isolates were ceftriaxone-susceptible; penicillin resistance (4.6%) was limited to meningitis. Case fatality was 5.0%. In multivariable analysis, sepsis (adjusted odds ratio [aOR] 20.82; 95% CI: 4.23-102.58)...