Cardiopulmonary morbidity of streptococcal infections in a PICU Kam-Lun E. Hon 1 , Antony Fu 1 , Ting Fan Leung 1 , Terence C. W. Poon 1 , Wai Hung Cheung 2 , Chor Yiu Fong 2 , Yee Ting Christina Ho 2 , Tsui Yin Jamie Lee 2 , Tam Man Ng 2 , Wai Ling Yu 2 , Kam Lau Cheung 1 , Vivian Lee 3 and Margaret Ip 4 1 Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong 2 Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong 3 School of Pharmacy, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong 4 Department of Microbiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Abstract Aim: The streptococci are important bacteria that cause serious childhood infec- tions. We investigated cardiopulmonary morbidity associated with streptococcal infection and pediatric intensive care unit (PICU) admission. Methods: A retrospective study between 2002 and 2013 of all children with a laboratory isolation of streptococcus. Results: There were 40 (2.3%) PICU patients with streptococcal isolations includ- ing Streptococcus pyogenes (Group A streptococcus, GAS, n = 7), Streptococcus agalactiae (Group B streptococcus, GBS, n = 5), Streptococcus pneumoniae (SP, n = 20), alpha-hemolytic (n = 4), beta-hemolytic (n = 2) and gama-hemolytic (n = 2) streptococci. Comparing among GAS, GBS and SP, respiratory isolates were more likely positive for GAS or SP (P = 0.033), whereas cerebrospinal fluid was more likely positive for GBS (P = 0.002). All GAS and GBS, and the majority of SP (90%) were sensitive to penicillin. All SP specimens were sensitive to cefotaxime and vancomycin. These infections were associated with high PICU mortality of 43%, 20% and 25%, respectively. Isolation of streptococci was associated with a 30% mortality and high rates of need for mechanical ventilatory and inotropic supports. Patients with GAS, SP or any streptococcal isolation had relative risks [95% confidence interval (CI), P value] of PICU deaths of 7.5 (CI 3.1–18.1, P < 0.0001), 4.5 (CI 2.0–9.8, P < 0.0002) and 5.7 (CI 3.4–9.5, P < 0.0001), respec- tively. In SP, older children had significantly higher prevalence of premorbid con- ditions such as malignancy, mental retardation/cerebral palsy ± seizure disorders, chromosomal or genetic disorders (P = 0.003) than children <5 years of age. Serotypes were available for some of these specimens that included 19A, 6B, 3 and 6C. There were four SP deaths with multiorgan system failure and hemolytic uremic syndrome (two 19A and two serotype 3). Conclusions: Severe streptococcal infections are associated with significant mor- bidity and mortality despite treatment with systemic antibiotics and intensive care unit support. GAS and SP affect the lungs of children, whereas GBS more likely causes meningitis in infants. The expanded coverage of newer polyvalent pneumococcal vaccines can probably prevent infections by serotypes 19A, 19F, 6B and 3. Please cite this paper as: Hon K-LE, Fu A, Leung TF, Poon TCW, Cheung WH, Fong CY, Ho YTC, Lee TYJ, Ng TM, Yu WL, Cheung KL, Lee V and Ip M. Cardiopul- monary morbidity of streptococcal infections in a PICU. Clin Respir J 2015; 9: 45–52. Key words agalactiae – hemolytic uremic syndrome – immunizations – pleural effusion – pneumococcus – pyogenes – serotypes – streptococcus Correspondence Kam-Lun E. Hon, MBBS, MD, FAAP, FCCM, Department of Pediatrics, The Chinese University of Hong Kong, 6/F, Clinical Sciences Building, Prince of Wales Hospital, Shatin, Hong Kong Tel: (852) 2632 2859 Fax: (852) 2636 0020 email: ehon@cuhk.edu.hk Received: 21 July 2013 Revision requested: 20 December 2013 Accepted: 04 January 2014 DOI:10.1111/crj.12103 Authorship and contributorship Hon K-LE is the principal author. Fu A and Leung TF are co-authors in writing the manuscript. Poon TC is responsible for the statistical analyses. Cheung WH, Fong CY, Ho YT, Lee TY, Ng TM and Yu WL are responsible for record review, data collection and verification. Cheung KL is the consultant pediatric intensivist in the care of the PICU patients. Lee V is the pharmacist and Ip M the microbiologist who provided inputs on the pneumococcal, antimicrobial and immunization aspects of the writing. Ethics Ethics approval for this review was obtained from the Clinical Research Ethics Committee of our university. Conflict of interest K-LE Hon has received travel and conference sponsorship from Pfizer (Wyeth). MI has received funds for sponsored study and consultancy work for Pfizer (Wyeth), and participated in studies funded by Novartis, and Janssen Pharmaceuticals. The Clinical Respiratory Journal ORIGINAL ARTICLE 45 The Clinical Respiratory Journal (2015) • ISSN 1752-6981 © 2014 John Wiley & Sons Ltd