Background: Streptococcus pneumoniae is a major global cause of invasive pneumococcal disease (IPD) and death. Introduction of the pneumococcal conjugate vaccine (PCV) has led to substantial declines in IPD incidence in many countries. Long-term, population-based studies on mortality trends among survivors of acute IPD are scarce. Methods: Data encompassing all individuals diagnosed with IPD in Iceland from 1975 to 2020 were analyzed. Diagnosis required a positive blood or cerebrospinal fluid culture. 30-day and 5-year mortality rates were assessed across 3 decades (1985–2014), adjusting for multiple covariates. Additionally, age-standardized all-cause mortality rates were compared between patients with IPD and the general population. Results: The cohort included 1463 patients of all ages. Invasive pneumococcal disease incidence peaked in 1995–2004 and declined significantly thereafter (P < .001). Serotype 7F was the most prevalent. No improvement in short-term mortality at 30 days was detected over time (P = .98). A modest improvement in 5-year mortality was observed, although this did not reach statistical significance (P = .076). Even when early deaths were excluded, the ASR for all-cause mortality in patients with IPD was 2.6 times higher than in the general population (0.021 vs 0.008 per person-year). Conclusions: IPD incidence declined substantially over time, particularly following the introduction of the 10-valent PCV in 2011, yet short-term mortality remained unchanged. A modest improvement in long-term mortality was observed, possibly reflecting advances in chronic disease management. Invasive pneumococcal disease survivors face significantly elevated long-term mortality compared to the general population. Targeted interventions are needed to reduce short-term mortality associated with IPD.

Febrile episodes are common in children and the most frequent reason for attending emergency services. Although most infections have a benign and self-limiting course, severe and sometimes life-threatening infections occur. This prospective study describes a cohort of children presenting to a single-centre pediatric emergency department (ED) with suspected invasive bacterial infection, and explores the relationships between nasopharyngeal microbes and outcomes. All children attending the ED who had a blood culture taken were offered to participate over a two-year period. In addition to conventional medical care, a nasopharyngeal swab was obtained., which was analysed for respiratory viruses and three bacterial species using a quantitative PCR. Fisher’s exact test, Wilcoxon rank sum, and multivariable models were used for statistical analyses of the 196 children (75% younger than four years) who were enrolled and had sufficient data for analysis; 92 had severe infections according to the study protocol, while five had bloodstream infections. Radiologically confirmed pneumonia was the most common severe infection found in 44/92 patients. The presence of respiratory viruses and the carriage of Streptococcus pneumoniae and Haemophilus influenzae were associated with a higher risk of pneumonia. Higher density colonisation with these bacteria were independent risk factors for pneumonia, whereas Moraxella catarrhalis carriage was associated with lower risk. Our data support the hypothesis that higher nasopharyngeal density of pneumococci and H. influenzae could play a role in the development of bacterial pneumonia in children. A preceding viral infection of the respiratory tract may be a trigger and play a role in the progression to severe lower respiratory tract infection.

Introduction: Increasing evidence indicates an association between nutritional status and Coronavirus disease 2019 (COVID-19) disease severity. The aim of the study was to describe the risk of malnutrition, body mass index (BMI) and vitamin D status of hospitalised COVID-19 patients and assess whether they are associated with duration of hospital stay, intensive care unit (ICU) admission, mechanical ventilation, and mortality. Methods: The study is a descriptive retrospective study of 273 patients with COVID-19 admitted to Hospital from February 2020 to March 2021. Patients were screened for risk of malnutrition using a validated screening tool. BMI was calculated from height and weight. Insufficient Vitamin D status was defined as 25(OH)vitD 7 days, ICU admission, mechanical ventilation, and mortality. Interaction between risk of malnutrition and BMI of >= 30 kg/m(2) was assessed using the likelihood ratio test with hospital stay, ICU admission, mechanical ventilation, and mortality as outcomes. Results: Screening for risk of malnutrition identified 201 (74%) patients at a medium to high risk of malnutrition. Patients defined as being at a medium or high risk of malnutrition were more likely to be hospitalised for >7 days compared to those defined as low risk (OR: 10.72; 95% CI: 3.9-29.46; p < 0.001 and OR: 61.57; 95% CI: 19.48-194.62; p < 0.001, respectively). All patients who were admitted to ICU (n = 41) and required mechanical ventilation (n = 27) were defined as having medium or high risk of malnutrition. High risk of malnutrition was also associated with increased odds of mortality (OR: 8.87; 955 CI 1.08-72,96; p = 0.042). BMI of >= 30 kg/m(2) (43%) and 25(OH)vitD 7 days or mortality, although BMI >= 30 kg/m(2) was associated with increased risk of ICU admission (OR: 7.12; 95% CI: 1.59-31.94; p = 0.010) and mechanical ventilation (OR: 8.86; 95% CI: 1.12-69.87; p = 0.038). Interactions between risk of malnutrition and BMI >= 30 kg/m(2) were not significant to explain the outcomes of hospital stay >7 days, ICU admission, mechanical ventilation, or mortality. Conclusion: High risk of malnutrition among hospitalised COVID-19 patients was associated with longer duration of hospital stay, ICU admission, mechanical ventilation and mortality, and BMI >= 30 kg/m(2) was associated with ICU admission and mechanical ventilation. Insufficient Vitamin D status was not associated with duration of hospital stay, ICU admission, mechanical ventilation, or mortality. (c) 2024 The Author(s). Published by Elsevier Ltd on behalf of European Society for Clinical Nutrition and Metabolism. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).