Epidemiological Profile of Patients Hospitalized with Pneumonia and Identification of Streptococcus pneumoniae in a Brazilian Pediatric Hospital

Background

Streptococcus pneumoniae (S. pneumoniae) is one of the leading bacterial causes of pneumonia worldwide, contributing significantly to morbidity and mortality. According to 2019 data from the United Nations Children's Fund (UNICEF), one child dies from pneumonia every 43 seconds, despite it being a vaccine-preventable disease. This study aimed to profile patients hospitalized with pneumonia where S. pneumoniae was identified in sterile fluid cultures.

Methods

A retrospective, quantitative, and qualitative study was conducted from July 2021 to July 2024, including patients aged 0 to 18 years. Data were collected from electronic medical records of patients admitted to a pediatric hospital in southern Brazil with a diagnosis of pneumonia and sterile fluid cultures positive for S. pneumoniae.

Results

A total of 44 patients were included, of whom 80% were under 5 years old and 63% were male. Regarding vaccination status, 61% had no records in the electronic medical system. Among patients with available records, all had received the 10-valent pneumococcal conjugate vaccine (provided by the public health system).

Complications such as pleural effusion occurred in 75% of cases, with 94% of these requiring surgical intervention. S. pneumoniae was identified in pleural fluid in 64% of patients undergoing drainage, while others had positive blood cultures. Antimicrobial susceptibility analysis showed that 30% of isolates were resistant to penicillin, with no resistance observed for ceftriaxone or vancomycin.

Despite this, 84% of treatments were initiated empirically with third-generation cephalosporins. The average hospital stay was 18 days (ranging from 1 to 48 days). In terms of clinical outcomes, 95% of patients achieved clinical cure, 1 patient required readmission, and 1 patient died on the day of admission.

Conclusions

Most cases of pneumonia associated with S. pneumoniae occurred in children under 5 years old, with a predominance in males. A significant proportion required surgical intervention. Although penicillin resistance was observed in 30% of isolates, the predominant empirical use of third-generation cephalosporins demonstrated clinical efficacy, leading to a 95% cure rate. These findings highlight the importance of targeted therapeutic strategies and preventive measures, such as improving vaccine coverage and optimizing antimicrobial use, to minimize complications and reduce bacterial resistance.