Clinical Manifestations and Molecular Epidemiology of Necrotizing Pneumonia and Empyema Caused by Streptococcus Pneumoniae in Children in Taiwan

Recently, there have been increasing numbers of pneumococcal pneumonia cases, with their associated complications. We conducted a retrospective review to increase the understanding of childhood pneumococcal pneumonia. Seventy- one patients with pneumococcal pneumonia were identified. Forty ( 56.3%) of them developed complicated pneumonia. Multivariate analysis showed that presence of immature polymorphonuclear leukocytes in peripheral blood (odds ratio [OR], 3.67; 95% confidence interval [CI], 1. 08 - 12.63), high C-reactive protein levels ( 112 mg/dL) ( OR, 5.24; 95% CI, 1.10 - 24.93), and no underlying disease at presentation ( OR, 5.48; 95% CI, 1.06 - 28.25) were independent predictors of the occurrence of necrosis or/and abscess. Fourteen isolates (35%), which were genotypically identical and had the same pulsed-field gel electrophoresis pattern ( serogroup 14, with MICs of penicillin of 0.1 - 0.5 mug/mL), were significantly associated with complicated pneumonia (p= .047). Whether the virulence of antibiotic-resistant pneumococci is evolving deserves further investigation.