The burden of bacteremia and invasive diseases in children aged less than five years with fever in Italy

Chiara Azzari, Maria Moriondo, Pasquale Di Pietro, Cesare Di Bari, Massimo Resti, Francesco Mannelli, Susanna Esposito, Guido Castelli-Gattinara, Antonio Campa, Fernando Maria De Benedictis, Gianni Bona, Lisa Comarella, Katsiaryna Holl, Federico Marchetti

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Background: Invasive diseases (ID) caused by Streptococcus pneumoniae (S. pneumoniae), Haemophilus influenzae (H. influenzae), and Neisseria meningitidis are a major public health problem worldwide. Comprehensive data on the burden of bacteremia and ID in Italy, including data based on molecular techniques, are needed. Methods: We conducted a prospective, multi-centre, hospital-based study (GSK study identifier: 111334) to assess the burden of bacteremia and ID among children less than five years old with a fever of 39 °C or greater. Study participation involved a single medical examination, collection of blood for polymerase chain reaction (PCR) and blood culture, and collection of an oropharyngeal swab for colonization analysis by PCR. Results: Between May 2008 and June 2009, 4536 patients were screened, 944 were selected and 920 were enrolled in the study. There were 225 clinical diagnoses of ID, 9.8 % (22) of which were bacteremic. A diagnosis of sepsis was made for 38 cases, 5.3 % (2) of which were bacteremic. Among the 629 non-ID diagnoses, 1.6 % (10) were bacteremic. Among the 34 bacteremic cases, the most common diagnoses were community-acquired pneumonia (15/34), pleural effusion (4/34) and meningitis (4/34). S. pneumoniae was the most frequently detected bacteria among bacteremic cases (29/34) followed by H. influenzae (3/34). Ninety percent (27/30) of bacteremic patients with oropharyngeal swab results were colonized with the studied bacterial pathogens compared to 46.1 % (402/872) of non-bacteremic cases (p <0.001). PCV7 (7-valent pneumococcal conjugate vaccine) vaccination was reported for 55.9 % (19/34) of bacteremic cases. S. pneumoniae serotypes were non-vaccine serotypes in children who had been vaccinated. Mean duration of hospitalization was longer for bacteremic cases versus non-bacteremic cases (13.6 versus 5.8 days). Conclusions: These results confirm that S. pneumoniae is one of the pathogens frequently responsible for invasive disease.

Original languageEnglish
Article number189
JournalItalian Journal of Pediatrics
Issue number1
Publication statusPublished - Nov 20 2015


  • Bacteremia
  • Fever
  • Haemophilus influenzae
  • Invasive disease
  • Pneumococcal vaccine
  • Streptococcus pneumoniae

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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