1176. Experience with PCV10 Implementation in Colombia and More Severe Course of Pneumococcal Pneumonia in children: A Multicenter Study, 2008 – 2019 (Neumocolombia Network)

Background Pneumococcal conjugate vaccines (PCV) have decreased pneumonia in children. Colombia introduced massive vaccination with PCV10 in 2012. Methods Pneumococcal pneumonia cases from 10 hospitals part of an active surveillance network for invasive pneumococcal disease were included. Two periods were compared, pre-PCV10: 2008-2012 and post-PCV10: 2014-2019. The objective was to compare characteristics and outcomes before and after PCV10. Results 370 cases were included. Serotype 1(15, 11.2%) and 14 (33, 24.6%) were the most frequent in Pre-PCV10, with only 4(3%) 19A and 1(0.7%) serotype 3. Post-PCV10, serotype 1 decreased to 6(3.1%), 14 to 15(7.8%), while 19A increased to 58(30.2%), serotype 3 to 32(16.7%) and 6A to 7(3.6%) (p = < 0.001), (Graph 1). Complicated pneumonia (CN) also increased (13.4% to 31,8%) (p< 0,001). Pre-PVC10, 44% of CN were due to PCV10 serotypes; with no PCV13 serotypes cases. Post-vaccine period, PCV10 explained only 8.2% and PCV13 60.6%(p < 0.001) of CN. Comparing PICU requirement among predominant serotypes on each period; 23.5% of serotypes 14 and 27.2% of serotypes 1 were admitted, while 59.4% of serotypes 3, 56.9 % of 19A and 42.8% of 6A required PICU. The median of hospitalization increased from 8(5.5-15) to 12 (7-22) days (p < 0.001), as well as the frequency of PICU, 32.8% to 51.6 %, (p = 0.001). Penicillin prescription was similar (17.2% -15.7%), with decrease in ampicillin use (28.4% - 3.6%) and increase ampicillin-sulbactam (0.7% to 24%), and ceftriaxone / clindamycin (0.7% to 5.7%) in post-PCV10. The duration of empirical antibiotic treatment was 7(4-11) and increased to 10(6-17) (p = < 0.001). Lethality showed a slight, non-significant increase between periods 7.5% vs. 9.9% (p = 0.57). (Table1) Graph 1. Serotype distribution 2008 - 2019 Year 2012, PCV10 introduced 2 + 1 schedule. Table 1. Outcomes in the Pre-PCV10 and Post-PCV10 Period Conclusion PCV10 significantly decreased vaccine serotypes, with increase in PCV13 serotypes. 19A, 3 and 6A the predominant serotypes had greater severity including PICU admission, CN and more resistance, with an increase in the use of broad-spectrum antibiotics and longer hospitalization. The current data support national and regional evidence on the importance of replacing PCV10 to a higher valence that include 19A, as PCV13, with the aim of reducing the circulation, particularly of this serotype. Disclosures Ivan Felipe Gutiérrez Tobar, n/a, Pfizer and MSD (Advisor or Review Panel member, Research Grant or Support, Speaker’s Bureau, Has received support from Pfizer and MSD for participation in congresses and has received conference payments from Pfizer)Pfizer and MSD (Speaker’s Bureau, Other Financial or Material Support, Has received support from Pfizer for participation in congresses) Cristina Mariño Drews, n/a, Pfizer (Other Financial or Material Support, Has received support from Pfizer for participation in congresses) Sandra Beltran, n/a, Pfizer (Other Financial or Material Support, Has received support from Pfizer for participation in congresses) Aura Lucia Leal Castro, MD, Pfizer and MSD (Research Grant or Support, Speaker’s Bureau, Other Financial or Material Support, Has received support from Pfizer for participation in congresses) Aura Lucia Leal Castro, n/a, Pfizer and MSD (Research Grant or Support, Speaker’s Bureau, Other Financial or Material Support, Has received support from Pfizer for participation in congresses) Jaime alberto Patiño-Niño, n/a, Pfizer (Research Grant or Support, Speaker’s Bureau, Other Financial or Material Support, Has received support from Pfizer for participation in congresses) Martha Isabel Alvarez-Olmos, n/a, Pfizer (Other Financial or Material Support, Has received support from Pfizer for participation in congresses) Rocio Barrero Barreto, n/a, Pfizer and MSD (Other Financial or Material Support, Has received support from Pfizer and MSD for participation in congresses and has received conference payments from Pfizer) Fabio Espinosa, n/a, MSD (Research Grant or Support, Other Financial or Material Support, Has received support from MSD for other research.) Nicolas Ramos, n/a, Pfizer (Other Financial or Material Support, Has received support from Pfizer for participation in congresses) Vivian Marcela Moreno Mejia, n/a, Pfizer (Research Grant or Support)

Paediatric empyema: are ultrasound characteristics at the time of intervention predictive of treatment failure?

Background: Parapneumonic effusions and empyema are the most frequent complication of paediatric pneumonia. Treatment options include chest drain and fibrinolytics (CDF) or thoracoscopic surgery. CDF is considered less invasive, more cost effective though with higher rates of reintervention. Pleural fluid characteristics on ultrasound may identify cases at increased risk of treatment failure with primary CDF. Methods: A retrospective cohort 2011-2018 of complicated pneumonia managed with primary CDF. Cases were reviewed using ultrasound criteria to describe pleural fluid. We compared ultrasound findings and treatment failure. Results: We report 137 cases with a median age 3.8 years and 43% female. Treatment failure occurred for 32/137 (23%) cases. The interobserver reliability was substantial for the number of septations (Kappa 0.72, 95% CI 0.6 to 0.8), moderate for the size of the largest locule (Kappa 0.55, 95% CI 0.4 to 0.7) and fair for the level of echogenicity (Kappa 0.22, 95%CI 0.1 to 0.3), pleural thickening (Kappa 0.28, 95% CI 0.2 to 0.4), maximum effusion depth (Kappa 0.37, 95%CI 0.2 to 0.5) and radiologist’s risk for reintervention (Kappa 0.32, 95% CI 0.2 to 0.5). Hyperechoic pleural fluid was associated with treatment failure, with cases nearly five times more likely than anechoic fluid to have a reintervention (OR 4.9 95%CI 1.7 to 14.2, p=0.04). Treatment failure was not associated with other variables. Conclusion: We did not find an association between ultrasound characteristics and treatment failure for complicated pneumonia managed with primary CDF. Inter-observer agreement of ultrasound findings was difficult despite more objective criteria.

Predictive factors of COVID-19 pneumonia: a retrospective cross-sectional survey in a Japanese university hospital

BackgroundThe predictive factors of coronavirus disease 2019 (COVID-19) pneumonia, including clinical parameters with symptoms, vital signs, and laboratory data, have not been compared directly between cases with and without complicated pneumonia. AimsWe aimed to identify predictive factors for COVID-19 patients with complicated pneumonia, and determine which COVID-19 patients should undergo computed tomography (CT). MethodsThis retrospective cross-sectional survey was conducted at the Juntendo University Nerima Hospital in Tokyo, Japan. We recruited patients diagnosed with COVID-19 between 1 January and 31 December 2020 and all patients underwent blood tests and CT. Clinical information, including vital signs, symptoms, laboratory results, and CT findings, were extracted from medical charts. Factors potentially predicting COVID-19 pneumonia were analysed using Student’s t -test or the chi-squared test, and variables with a p- value of < 0.05 in the bi-variate analysis were entered into multivariate logistic regression models. ResultsAmong 221 included patients (119 males [53.8%]; mean age, 54.59 ± 18.61 years), 160 (72.4%) had pneumonia. The significant factors in the multi-variate analysis were the lactate dehydrogenase (odds ratio [OR], 3.41; 95% confidence interval [CI], 1.47–7.95; p < 0.01) and C-reactive protein (OR, 3.94; 95% CI, 1.05–14.80; p = 0.04) levels. No significant differences were observed in vital signs and the symptoms. ConclusionLDH and CRP level of > 220 IU/L and > 3.0 mg/dL, respectively, are independent risk factors for COVID-19 pneumonia. The present results are extremely useful for deciding whether to perform CT among COVID-19 patients.

Risk Factors Of Complicated Pneumonia In Children

Introduction: Pneumonia causes morbidity and mortality in children worldwide. Pediatric patients with complicated pneumonia have a poor prognosis and are more at risk of death. Objective To identify risk factors for complications in pediatric patients with pneumonia. Method: This research was a case-control study, involving children with pneumonia aged 1-59 months in Dr. Soetomo in 2016-2020. The sample was divided into two groups. Patients who had complications at first admission were classified as a case group. Whereas patients without complications at first admission were classified as a control group. Samples for the case group were obtained by using total sampling method, while the control group employed random sampling technique. Data were collected from medical records and analyzed by chi-square test. Result: A total of 44 case group samples and 53 control group samples were involved during this study. Among investigated variables, male gender (OR=2,842; 95% CI, 1,24-6,49) and anemia (OR=3,283; 95% CI, 1,26-8,49) might increase the risk of complicated pneumonia. Meanwhile other variables, namely age, comorbidities, birth weight, malnutrition, and immunization status did not have a significant relationship with the incidence of complications in pneumonia patients. Conclusion: Male gender and anemia are risk of complicated pneumonia.

Determine the Clinical Presentation and Outcomes of Thoracostomy in Children with Complicated Pneumonia

Objective: To examine the clinical presentation and outcomes of thoracostomy in patients presented with complicated pneumonia. Study Design: Descriptive/Observational Place and Duration of Study: Department of Paediatric Surgery, DHQ Teaching Hospital Sahiwal from 1st January 2019 to 31st December 2020. Methodology: Fifty patients of both genders with ages 0 to 12 years presented with complicated pneumonia were included. All the patients received chest tube intubation. Outcomes of thoracostomy were examined. Radiological examination was done. Results: Thirty eight (76%) patients were males while 24% were females. Majority of patients 64% were ages less than 5 years. Fever, cough, shortness of breath and chest pain were the common symptoms. Staphylococcus aureus was the most common causative factor found in 56% cases followed by streptococcus in 24% cases. 84% cases were successfully removed chest tube. Recollection found in 8% cases, pneumothorax found in 4% patients and 4% patients had pneumatocele. Conclusion: Chest tube intubation was the safe and effective treatment modality for complicated pneumonia with fewer rates of complications. Keywords: Complicated pneumonia, Thoracostomy, Empyema, Pneumothorax, Outcomes

Determinants of Complicated Pneumonia in Hospitalized Pediatric Patients

Pediatric complicated pneumonia (PCOMP) is the leading cause of mortality in children under the age of five. The study was conducted to determine the epidemiological and clinical characteristics of children with PCOMP. A retrospective study was carried out among all pediatric patients who were hospitalized due to complicated pneumonia in Abuzar Hospital (Ahvaz, Iran) during two years. The patients were evaluated in terms of epidemiological and clinical characteristics. A total of 65 hospitalized children and infants were identified. More than half of the patients were females (n=36; 55.3%). Their mean age was 4.21±3.80 years (range six months-15 years), and 64.1% of them (n=42) were under the age of five. There were 12 (19.4%) patients with failure to thrive (FTT). In addition, 58.5% of patients (n=38) had no history of hospitalization, and 66.2% of them (n=43) did not have any underlying disease. The mean length of hospital stay (LOS) was 12.46±6.85 (range 4-45) days. Admission was more common in winter (40%) and autumn (33.8%). Moreover, there were no significant associations between the types of complications and patients’ gender, age, FTT, and LOS. Further studies are warranted to identify factors contributing to disease severity and develop appropriate strategies for the prevention and treatment of PCOMP among Iranian children.

#16: Use of a Multiplex PCR Panel for Diagnosis of Complicated Pneumonia in Pediatrics

Background Pleural fluid cultures performed in the period from April 2015 to April 2017 (prior to having the test) were reviewed, 120 cultures were found, of which 7.5% were positive. Methods Descriptive study in patients from 0 to 12 years old, from April 2017 to April 2019, at Roosevelt Hospital, Guatemala City, June 2019 Results In the period from April 2017 to April 2019, pleural fluids were evaluated in which multiplex PCR was performed, obtaining 41 results, 24 positive PCR for pneumonia producing bacteria in the community, of which only 1 positive culture was found, which, if correlated, which means 25 times more detection capacity, than the Gold standard of culture. Forty-one cultures of pleural fluids were evaluated, of which 58% were detected by FilmArray® The most frequently isolated microorganisms were Streptococcus pneumoniae 42%, Streptococcus sp. 3% Haemophilus influenzae 13% and Pseudomonas aeruginosa 3% Conclusion The use of Multiplex PCR in pleural fluid allowed the identification of a high percentage of microorganisms in the pleural fluid. Although the test is not valid for this use, its use could mean a great advantage for the etiological diagnosis.