Skip to main content

Advertisement

Log in

Pediatric osteoarticular infections caused by Streptococcus pneumoniae before and after the introduction of the heptavalent pneumococcal conjugate vaccine

  • Article
  • Published:
European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

Abstract

Streptococcus pneumoniae is an uncommon cause of osteoarticular infections (OAI) in children. The objective of this study was to investigate the clinical and laboratory characteristics of pneumococcal OAI before and after the introduction of the heptavalent pneumococcal conjugate vaccine (PCV7). Data were retrospectively collected from children aged <16 years who were hospitalized for pneumococcal OAI between 1997 and 2007 in four Parisian teaching hospitals. Forty-three children were included (32 with arthritis and 11 with osteomyelitis) and the median age of these children was 12.5 months (range 3 months to 14 years). Serotypes were available for 19/43 strains (44 %) from 1997 onwards and for 12/13 strains (92 %) from 2005 onwards. Seven unvaccinated children were infected with vaccine serotypes and we observed only one vaccine failure. After the introduction of PCV7, we noted an increase in short-term complications and the emergence of serotype 19A, which was penicillin-intermediate in 86 % of cases. After PCV7 introduction, serotype 19A was the most frequent serotype implicated in pediatric pneumococcal OAI. The 13-valent pneumococcal conjugate vaccine introduced in France in June 2010 should cover the emerging serotype.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Arnold SR, Elias D, Buckingham SC, Thomas ED, Novais E, Arkader A, Howard C (2006) Changing patterns of acute hematogenous osteomyelitis and septic arthritis: emergence of community-associated methicillin-resistant Staphylococcus aureus. J Pediatr Orthop 26(6):703–708

    Article  PubMed  Google Scholar 

  2. De Boeck H (2005) Osteomyelitis and septic arthritis in children. Acta Orthop Belg 71(5):505–515

    PubMed  Google Scholar 

  3. Gavilán MG, López JB, Artola BS (1999) Peculiarities of osteo-articular infections in children. Baillieres Best Pract Res Clin Rheumatol 13(1):77–94

    Article  PubMed  Google Scholar 

  4. Carrillo-Marquez MA, Hulten KG, Hammerman W, Mason EO, Kaplan SL (2009) USA300 is the predominant genotype causing Staphylococcus aureus septic arthritis in children. Pediatr Infect Dis J 28(12):1076–1080

    Article  PubMed  Google Scholar 

  5. Faden H, Grossi M (1991) Acute osteomyelitis in children. Reassessment of etiologic agents and their clinical characteristics. Am J Dis Child 145(1):65–69

    PubMed  CAS  Google Scholar 

  6. Ibia EO, Imoisili M, Pikis A (2003) Group A beta-hemolytic streptococcal osteomyelitis in children. Pediatrics 112(1 Pt 1):e22–e26

    Article  PubMed  Google Scholar 

  7. Moumile K, Merckx J, Glorion C, Pouliquen JC, Berche P, Ferroni A (2005) Bacterial aetiology of acute osteoarticular infections in children. Acta Paediatr 94(4):419–422

    Article  PubMed  CAS  Google Scholar 

  8. Unkila-Kallio L, Kallio MJ, Peltola H (1993) Acute haematogenous osteomyelitis in children in Finland. Finnish Study Group. Ann Med 25(6):545–549

    PubMed  CAS  Google Scholar 

  9. Ilharreborde B, Bidet P, Lorrot M, Even J, Mariani-Kurkdjian P, Liguori S, Vitoux C, Lefevre Y, Doit C, Fitoussi F, Penneçot G, Bingen E, Mazda K, Bonacorsi S (2009) New real-time PCR-based method for Kingella kingae DNA detection: application to samples collected from 89 children with acute arthritis. J Clin Microbiol 47(6):1837–1841

    Article  PubMed  CAS  Google Scholar 

  10. Lundy DW, Kehl DK (1998) Increasing prevalence of Kingella kingae in osteoarticular infections in young children. J Pediatr Orthop 18(2):262–267

    Article  PubMed  CAS  Google Scholar 

  11. Bowerman SG, Green NE, Mencio GA (1997) Decline of bone and joint infections attributable to Haemophilus influenzae type b. Clin Orthop Relat Res 341:128–133

    Article  PubMed  Google Scholar 

  12. Howard AJ (1992) Haemophilus influenzae type b vaccines. Br J Hosp Med 48(1):44–46

    PubMed  CAS  Google Scholar 

  13. Bradley JS, Kaplan SL, Tan TQ, Barson WJ, Arditi M, Schutze GE, Wald ER, Givner LB, Mason EO (1998) Pediatric pneumococcal bone and joint infections. The Pediatric Multicenter Pneumococcal Surveillance Study Group (PMPSSG). Pediatrics 102(6):1376–1382

    Article  PubMed  CAS  Google Scholar 

  14. Jacobs NM (1991) Pneumococcal osteomyelitis and arthritis in children. A hospital series and literature review. Am J Dis Child 145(1):70–74

    PubMed  CAS  Google Scholar 

  15. Kaplan SL, Mason EO Jr, Wald E, Tan TQ, Schutze GE, Bradley JS, Givner LB, Kim KS, Yogev R, Barson WJ (2002) Six year multicenter surveillance of invasive pneumococcal infections in children. Pediatr Infect Dis J 21(2):141–147

    Article  PubMed  Google Scholar 

  16. Bonhoeffer J, Haeberle B, Schaad UB, Heininger U (2001) Diagnosis of acute haematogenous osteomyelitis and septic arthritis: 20 years experience at the University Children’s Hospital Basel. Swiss Med Wkly 131(39–40):575–581

    PubMed  CAS  Google Scholar 

  17. Chusid MJ, Sty JR (1981) Pneumococcal arthritis and osteomyelitis in children. Clin Pediatr (Phila) 20(2):105–107

    Article  CAS  Google Scholar 

  18. Hadari I, Dagan R, Gedalia A, Jeanine N, Moses S (1985) Pneumococcal osteomyelitis. An unusual cluster of cases. Clin Pediatr (Phila) 24(3):143–145

    Article  CAS  Google Scholar 

  19. Hsu K, Pelton S, Karumuri S, Heisey-Grove D, Klein J; Massachusetts Department of Public Health Epidemiologists (2005) Population-based surveillance for childhood invasive pneumococcal disease in the era of conjugate vaccine. Pediatr Infect Dis J 24(1):17–23

    Article  PubMed  Google Scholar 

  20. Pilishvili T, Lexau C, Farley MM, Hadler J, Harrison LH, Bennett NM, Reingold A, Thomas A, Schaffner W, Craig AS, Smith PJ, Beall BW, Whitney CG, Moore MR; Active Bacterial Core Surveillance/Emerging Infections Program Network (2010) Sustained reductions in invasive pneumococcal disease in the era of conjugate vaccine. J Infect Dis 201(1):32–41

    Article  PubMed  Google Scholar 

  21. Poehling KA, Talbot TR, Griffin MR, Craig AS, Whitney CG, Zell E, Lexau CA, Thomas AR, Harrison LH, Reingold AL, Hadler JL, Farley MM, Anderson BJ, Schaffner W (2006) Invasive pneumococcal disease among infants before and after introduction of pneumococcal conjugate vaccine. JAMA 295(14):1668–1674

    Article  PubMed  CAS  Google Scholar 

  22. Whitney CG, Farley MM, Hadler J, Harrison LH, Bennett NM, Lynfield R, Reingold A, Cieslak PR, Pilishvili T, Jackson D, Facklam RR, Jorgensen JH, Schuchat A; Active Bacterial Core Surveillance of the Emerging Infections Program Network (2003) Decline in invasive pneumococcal disease after the introduction of protein-polysaccharide conjugate vaccine. N Engl J Med 348(18):1737–1746

    Article  PubMed  Google Scholar 

  23. Shinefield HR, Black S (2000) Efficacy of pneumococcal conjugate vaccines in large scale field trials. Pediatr Infect Dis J 19(4):394–397

    Article  PubMed  CAS  Google Scholar 

  24. Cavallo JD, Chardon H, Chidiac C, Courvalin P, Dabernat H, Drugeon H, Dubreuil L, Goldstein F, Guery B, Jarlier V, Lambert T, Leclercq R, Nicolas-Chanoine MH, Quentin C, Rouveix B, Soussy CJ, Varon E (2008) Recommandations 2008. Comité de l’Antibiogramme de la Société Française de Microbiologie. http://www.sfm-microbiologie.org/UserFiles/file/CASFM/casfm_2008.pdf

  25. Ross JJ, Saltzman CL, Carling P, Shapiro DS (2003) Pneumococcal septic arthritis: review of 190 cases. Clin Infect Dis 36(3):319–327

    Article  PubMed  Google Scholar 

  26. Hellerstein A, Wiedermann BL (1987) Pneumococcal sacroiliitis in an infant. Pediatr Infect Dis J 6(8):759–761

    PubMed  CAS  Google Scholar 

  27. Kalouche I, Ghanem I, Kharrat K, Dagher F (2005) Osteomyelitis of the rib due to Streptococcus pneumoniae: a very rare condition in children. J Pediatr Orthop B 14(1):55–60

    Article  PubMed  Google Scholar 

  28. Malleson PN, Gross KR, Hardyment A, Petty RE (1988) Pneumococcal vertebral osteomyelitis presenting with an aseptic knee effusion in a child. Clin Exp Rheumatol 6(3):325–328

    PubMed  CAS  Google Scholar 

  29. O’Brien CM, Darley ES, Kelly AJ, Nelson IW (1998) Septic sacroiliitis: an unusual causative organism in a rare condition. Int J Clin Pract 52(3):206–207

    PubMed  Google Scholar 

  30. Perez A, Padilla E, Marco A, De Otero J, Bandiera D, Marimón I (2008) Pneumococcal sacroiliitis in a 4-year-old boy. Scand J Rheumatol 37(4):310–312

    Article  PubMed  CAS  Google Scholar 

  31. Pocheville I, Gutierrez C, Villas P, Noguerales F, Hernandez JL (1995) Pneumococcal vertebral osteomyelitis: a clinical case. Pediatr Infect Dis J 14(2):160–161

    Article  PubMed  CAS  Google Scholar 

  32. Kocher MS, Zurakowski D, Kasser JR (1999) Differentiating between septic arthritis and transient synovitis of the hip in children: an evidence-based clinical prediction algorithm. J Bone Joint Surg Am 81(12):1662–1670

    PubMed  CAS  Google Scholar 

  33. Grant CC, Harnden AR, Jewell G, Knox K, Peto TE, Crook DW (2003) Invasive pneumococcal disease in Oxford, 1985–2001: a retrospective case series. Arch Dis Child 88(8):712–714

    Article  PubMed  CAS  Google Scholar 

  34. Kaltoft MS, Zeuthen N, Konradsen HB (2000) Epidemiology of invasive pneumococcal infections in children aged 0–6 years in Denmark: a 19-year nationwide surveillance study. Acta Paediatr Suppl 89(435):3–10

    Article  PubMed  CAS  Google Scholar 

  35. Levine MM, Lagos R, Levine OS, Heitmann I, Enriquez N, Pinto ME, Alvarez AM, Wu E, Mayorga C, Reyes A (1998) Epidemiology of invasive pneumococcal infections in infants and young children in Metropolitan Santiago, Chile, a newly industrializing country. Pediatr Infect Dis J 17(4):287–293

    Article  PubMed  CAS  Google Scholar 

  36. Dubnov-Raz G, Ephros M, Garty BZ, Schlesinger Y, Maayan-Metzger A, Hasson J, Kassis I, Schwartz-Harari O, Yagupsky P (2010) Invasive pediatric Kingella kingae infections: a nationwide collaborative study. Pediatr Infect Dis J 29(7):639–643

    Article  PubMed  Google Scholar 

  37. Basmaci R, Lorrot M, Bidet P, Doit C, Vitoux C, Penneçot G, Mazda K, Bingen E, Ilharreborde B, Bonacorsi S (2011) Comparison of clinical and biologic features of Kingella kingae and Staphylococcus aureus arthritis at initial evaluation. Pediatr Infect Dis J 30(10):902–904

    Article  PubMed  Google Scholar 

  38. Ceroni D, Cherkaoui A, Ferey S, Kaelin A, Schrenzel J (2010) Kingella kingae osteoarticular infections in young children: clinical features and contribution of a new specific real-time PCR assay to the diagnosis. J Pediatr Orthop 30(3):301–304

    Article  PubMed  Google Scholar 

  39. Guillemot D, Varon E, Bernède C, Weber P, Henriet L, Simon S, Laurent C, Lecoeur H, Carbon C (2005) Reduction of antibiotic use in the community reduces the rate of colonization with penicillin G-nonsusceptible Streptococcus pneumoniae. Clin Infect Dis 41(7):930–938

    Article  PubMed  CAS  Google Scholar 

  40. Gaudelus J, Jean-Verdier B, Cohen R (2011) Evolution de la couverture vaccinale du vaccin pneumococcique conjugué de 2006 à 2010: analyse des carnets de santé. Méd Enf 31(4):187–190

    Google Scholar 

  41. Kempf M, Baraduc R, Bonnabau H, Brun M, Chabanon G, Chardon H, Croizé J, Demachy MC, Donnio PY, Dupont P, Fosse T, Gibel L, Gravet A, Grignon B, Hadou T, Hamdad F, Joly-Guillou ML, Koeck JL, Maugein J, Péchinot A, Ploy MC, Raymond J, Ros A, Roussel-Delvallez M, Segonds C, Vergnaud M, Vernet-Garnier V, Lepoutre A, Gutmann L, Varon E, Lanotte P (2011) Epidemiology and antimicrobial resistance of Streptococcus pneumoniae in France in 2007: data from the pneumococcus surveillance network. Microb Drug Resist 17(1):31–36

    Article  PubMed  Google Scholar 

  42. Pelton SI, Huot H, Finkelstein JA, Bishop CJ, Hsu KK, Kellenberg J, Huang SS, Goldstein R, Hanage WP (2007) Emergence of 19A as virulent and multidrug resistant Pneumococcus in Massachusetts following universal immunization of infants with pneumococcal conjugate vaccine. Pediatr Infect Dis J 26(6):468–472

    Article  PubMed  Google Scholar 

  43. Sirinavin S, Vorachit M, Thakkinstian A, Hongsanguensri S, Wittayawongsruji P (2003) Pediatric invasive pneumococcal disease in a teaching hospital in Bangkok. Int J Infect Dis 7(3):183–189

    Article  PubMed  Google Scholar 

  44. Brueggemann AB, Spratt BG (2003) Geographic distribution and clonal diversity of Streptococcus pneumoniae serotype 1 isolates. J Clin Microbiol 41(11):4966–4970

    Article  PubMed  CAS  Google Scholar 

  45. Henriques Normark B, Kalin M, Ortqvist A, Akerlund T, Liljequist BO, Hedlund J, Svenson SB, Zhou J, Spratt BG, Normark S, Källenius G (2001) Dynamics of penicillin-susceptible clones in invasive pneumococcal disease. J Infect Dis 184(7):861–869

    Article  PubMed  CAS  Google Scholar 

  46. Sirotnak AP, Eppes SC, Klein JD (1996) Tuboovarian abscess and peritonitis caused by Streptococcus pneumoniae serotype 1 in young girls. Clin Infect Dis 22(6):993–996

    Article  PubMed  CAS  Google Scholar 

  47. Greenberg D, Givon-Lavi N, Newman N, Bar-Ziv J, Dagan R (2011) Nasopharyngeal carriage of individual Streptococcus pneumoniae serotypes during pediatric pneumonia as a means to estimate serotype disease potential. Pediatr Infect Dis J 30(3):227–233

    Article  PubMed  Google Scholar 

  48. Angoulvant F, Bidet P, Doit C, Aubertin G, Soussan V, Bingen E, Bourrillon A, Faye A (2005) Serotype 6B pneumococcal meningitis in an immunocompetent infant immunized with heptavalent pneumococcal conjugated vaccine. Clin Infect Dis 40(3):494–495

    Article  PubMed  Google Scholar 

  49. Russell FM, Balloch A, Tang ML, Carapetis JR, Licciardi P, Nelson J, Jenney AW, Tikoduadua L, Waqatakirewa L, Pryor J, Byrnes GB, Cheung YB, Mulholland EK (2009) Immunogenicity following one, two, or three doses of the 7-valent pneumococcal conjugate vaccine. Vaccine 27(41):5685–5691

    Article  PubMed  CAS  Google Scholar 

  50. Dagan R (2009) Serotype replacement in perspective. Vaccine 27(Suppl 3):C22–C24

    Article  PubMed  CAS  Google Scholar 

  51. Kaplan SL, Barson WJ, Lin PL, Stovall SH, Bradley JS, Tan TQ, Hoffman JA, Givner LB, Mason EO Jr (2010) Serotype 19A Is the most common serotype causing invasive pneumococcal infections in children. Pediatrics 125(3):429–436

    Article  PubMed  Google Scholar 

  52. Messina AF, Katz-Gaynor K, Barton T, Ahmad N, Ghaffar F, Rasko D, McCracken GH Jr (2007) Impact of the pneumococcal conjugate vaccine on serotype distribution and antimicrobial resistance of invasive Streptococcus pneumoniae isolates in Dallas, TX, children from 1999 through 2005. Pediatr Infect Dis J 26(6):461–467

    Article  PubMed  Google Scholar 

  53. Richter SS, Heilmann KP, Dohrn CL, Riahi F, Beekmann SE, Doern GV (2009) Changing epidemiology of antimicrobial-resistant Streptococcus pneumoniae in the United States, 2004–2005. Clin Infect Dis 48(3):e23–e33

    Article  PubMed  Google Scholar 

  54. Kyaw MH, Lynfield R, Schaffner W, Craig AS, Hadler J, Reingold A, Thomas AR, Harrison LH, Bennett NM, Farley MM, Facklam RR, Jorgensen JH, Besser J, Zell ER, Schuchat A, Whitney CG; Active Bacterial Core Surveillance of the Emerging Infections Program Network (2006) Effect of introduction of the pneumococcal conjugate vaccine on drug-resistant Streptococcus pneumoniae. N Engl J Med 354(14):1455–1463

    Article  PubMed  CAS  Google Scholar 

  55. Lepoutre A, Varon E, Georges S, Gutmann L, Lévy-Bruhl D (2008) Impact of infant pneumococcal vaccination on invasive pneumococcal diseases in France, 2001–2006. Euro Surveill 13(35). pii: 18962

    Google Scholar 

  56. Levy C, Varon E, Bingen E, Lécuyer A, Boucherat M, Cohen R; Bacterial Meningitis Study Group (2011) Pneumococcal meningitis in French children before and after the introduction of pneumococcal conjugate vaccine. Pediatr Infect Dis J 30(2):168–170

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Philip Bastable for the editorial assistance and Emmanuelle Varon (Centre National de Référence des Pneumocoques, Paris) for serotyping the pneumococcal strains. We thank the physicians for their participation in this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to M. Lorrot.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lemaître, C., Ferroni, A., Doit, C. et al. Pediatric osteoarticular infections caused by Streptococcus pneumoniae before and after the introduction of the heptavalent pneumococcal conjugate vaccine. Eur J Clin Microbiol Infect Dis 31, 2773–2781 (2012). https://doi.org/10.1007/s10096-012-1627-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10096-012-1627-5

Keywords

Navigation