Burden of invasive pneumococcal disease, non-invasive all-cause pneumonia, and acute otitis media in hospitalized US children: a retrospective multi-center study from 2015-2020

Abstract Background Despite effective pneumococcal vaccines, pneumococcal disease (PD) exerts a substantial burden on children. This study explored the clinical and economic burden of invasive PD (IPD), non-invasive all-cause pneumonia (ACP), and acute otitis media (AOM) in hospitalized children, including those with antibiotic-resistant Streptococcus pneumoniae. Methods Data from the BD Insights Research Database of hospitalized children (<18 years) in the US were analyzed retrospectively. The study cohort included patients with an ICD10 code for IPD, ACP, or AOM and/or a positive culture for S. pneumoniae. Descriptive statistics and multivariable analyses evaluated the following outcomes: length of stay [LOS], hospital cost per admission, hospital margin per admission [costs – payments], and in-hospital mortality. Results The study included 4575 pediatric patients with IPD, ACP, or AOM admitted to 57 US hospitals from October 2015 to February 2020. Approximately half (50.7%) were under 2 years of age. The in-hospital mortality rate was 0.6% (n=28). The observed median (interquartile range) LOS was 4 (3, 5) days, cost per admission was $4,240 ($2,434, $8,311) US dollars, and hospital margin per admission was -$63 (‑$2,118, $2,025). Forty-one patients had S. pneumoniae-positive cultures and 56.1% of those cultures were resistant to ≥1 antibiotic class. Key variables associated with poor outcomes were having a moderate- or high-risk condition (chronic or immunocompromising), intensive care unit admission, and prior 90-day admission. Conclusions IPD, ACP, and AOM are associated with substantial clinical and economic burden in hospitalized pediatric patients in the US. S. pneumoniae isolates also showed high rates of resistance to antibiotics. Our data indicate the need for ongoing prevention efforts including vaccination and antimicrobial stewardship programs.