A historical perspective of MDR invasive pneumococcal disease in Spanish adults

2020 ◽  
Author(s):  
Jordi Càmara ◽  
Inmaculada Grau ◽  
Aida González-Díaz ◽  
Fe Tubau ◽  
Laura Calatayud ◽  
...  
Keyword(s):  
Risk Factors ◽  
Invasive Pneumococcal Disease ◽  
Older Patients ◽  
Clinical Characteristics ◽  
Pneumococcal Disease ◽  
Historical Perspective ◽  
Significant Proportion ◽  
Conjugate Vaccines ◽  
Resistant Disease ◽  
Resistance Rates

Abstract Objectives To analyse the clonal dynamics and clinical characteristics of adult invasive pneumococcal disease (IPD) caused by MDR and penicillin-non-susceptible (PNS) pneumococci in Spain. Methods All adult IPD episodes were prospectively collected (1994–2018). Streptococcus pneumoniae isolates were serotyped, genotyped and tested for antimicrobial susceptibility. Changes in the incidence of IPD were analysed and risk factors contributing to MDR were assessed by logistic regression. Results Of 2095 IPD episodes, 635 (30.3%) were caused by MDR/PNS isolates. Over the study period, the incidence of MDR/PNS-IPD decreased (IRR 0.70; 95% CI 0.53–0.93) whereas that of susceptible isolates remained stable (IRR 0.96; 95% CI 0.80–1.16). A reduction of resistance rates to penicillin (–19.5%; 95% CI –37% to 2%) and cefotaxime (–44.5%; 95% CI –64% to –15%) was observed. Two clones, Spain9V-ST156 and Denmark14-ST230, accounted for 50% of current resistant disease. Among current MDR/PNS isolates, 45.8% expressed serotypes not covered by the upcoming PCV15/PCV20 vaccines. MDR/PNS episodes were associated with older patients with comorbidities, nosocomial acquisition and higher 30 day mortality. MDR/PNS pneumococci were not independently associated with 30 day mortality in multivariate analysis [OR 0.826 (0.648–1.054)]. Conclusions Our study shows an overall reduction of MDR/PNS isolates in adults after the introduction of pneumococcal conjugate vaccines. However, a significant proportion of current resistant isolates are not covered by any of the upcoming PCV15/PCV20 vaccines. The burden of resistant disease is related to older patients with underlying conditions and caused by two major clones. Our data show that MDR is not a statistically significant factor related to increased mortality.

scholarly journals Pediatric Invasive Pneumococcal Disease Three Years after PCV13 Introduction in the National Immunization Plan—The Continued Importance of Serotype 3

2021 ◽  
Vol 9 (7) ◽  
pp. 1428
Author(s):  
Catarina Silva-Costa ◽  
Joana Gomes-Silva ◽  
Lúcia Prados ◽  
Mário Ramirez ◽  
José Melo-Cristino ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Antimicrobial Resistance ◽  
Conjugate Vaccine ◽  
Invasive Pneumococcal Disease ◽  
Pneumococcal Disease ◽  
Molecular Methods ◽  
Vaccine Uptake ◽  
Serotype Distribution ◽  
Conjugate Vaccines ◽  
National Immunization

The introduction of pneumococcal conjugate vaccines PCV7 and PCV13 led to decreases in incidence of pediatric invasive pneumococcal disease (pIPD) and changes in serotype distribution. We evaluated the consequences of higher vaccine uptake after the introduction of PCV13 in the National Immunization Plan (NIP) in 2015. Besides culture and conventional serotyping, the use of molecular methods to detect and serotype pneumococci in both pleural and cerebrospinal fluid samples contributed to 30% of all pIPD (n = 232) in 2015–2018. The most frequently detected serotypes were: 3 (n = 59, 26%), 10A (n = 17, 8%), 8 (n = 16, 7%) and 19A (n = 10, 4%). PCV13 serotypes still accounted for 46% of pIPD cases. Serotypes not included in any currently available conjugate vaccine (NVT) are becoming important causes of pIPD, with the increases in serotypes 8 and 33F being of particular concern given the importance of serotype 8 in adult IPD and the antimicrobial resistance of serotype 33F isolates. This study highlights the importance of using molecular methods in pIPD surveillance since these allowed a better case ascertainment and the identification of serotype 3 as the leading cause of pIPD. Even in a situation of vaccine uptake >95% for 3 years, PCV13 serotypes remain important causes of pIPD.

scholarly journals Pneumococcal Pneumonia and Invasive Pneumococcal Disease in Those 65 and Older: Rates of Detection, Risk Factors, Vaccine Effectiveness, Hospitalisation and Mortality

Geriatrics ◽  
2021 ◽  
Vol 6 (1) ◽  
pp. 13
Author(s):  
Roger E. Thomas
Keyword(s):  
Risk Factors ◽  
Nursing Home ◽  
Invasive Pneumococcal Disease ◽  
Disease Transmission ◽  
Pneumococcal Disease ◽  
Pneumococcal Pneumonia ◽  
Clinical Symptoms ◽  
Disease Incidence ◽  
Family Members ◽  
Vaccination Rates

Pneumococcal pneumonia (PP) and invasive pneumococcal disease (IPD) are important causes of morbidity and mortality in seniors worldwide. Incidence rates and serious outcomes worsen with increasing frailty, numbers of risk factors and decreasing immune competence with increasing age. Literature reviews in Medline and Embase were performed for pneumococcal disease incidence, risk factors, vaccination rates and effectiveness in the elderly. The introduction of protein-conjugated pneumoccal vaccines (PCV) for children markedly reduced IPD and PP in seniors, but serotypes not included in vaccines and with previously low levels increased. Pneumococcal polysaccharide (PPV23) vaccination does not change nasal and pharyngeal carriage rates. Pneumococcal and influenza vaccination rates in seniors are below guideline levels, especially in older seniors and nursing home staff. Pneumococcal and influenza carriage and vaccination rates of family members, nursing home health care workers and other contacts are unknown. National vaccination programmes are effective in increasing vaccination rates. Detection of IPD and PP initially depend on clinical symptoms and new chest X ray infiltrates and then varies according to the population and laboratory tests used. To understand how seniors and especially older seniors acquire PP and IPD data are needed on pneumococcal disease and carriage rates in family members, carers and contacts. Nursing homes need reconfiguring into small units with air ventilation externally from all rooms to minimise respiratory disease transmission and dedicated staff for each unit to minimise transmision of infectious diseaases.

scholarly journals Risk factors and comorbidities for invasive pneumococcal disease in Western Australian Aboriginal and non-Aboriginal people

Pneumonia ◽  
2014 ◽  
Vol 4 (1) ◽  
pp. 24-34 ◽  
Author(s):  
Faye J. Lima ◽  
Deborah Lehmann ◽  
Aoiffe McLoughlin ◽  
Catherine Harrison ◽  
Judith Willis ◽  
...  
Keyword(s):  
Risk Factors ◽  
Invasive Pneumococcal Disease ◽  
Pneumococcal Disease ◽  
Aboriginal People ◽  
Australian Aboriginal ◽  
Western Australian

Risk Factors for Pediatric Invasive Pneumococcal Disease in the Intermountain West, 1996–2002

2008 ◽  
Vol 18 (2) ◽  
pp. 139-146 ◽  
Author(s):  
Maryam B. Haddad ◽  
Christina A. Porucznik ◽  
Kerry E. Joyce ◽  
Anindya K. De ◽  
Andrew T. Pavia ◽  
...  
Keyword(s):  
Risk Factors ◽  
Invasive Pneumococcal Disease ◽  
Pneumococcal Disease ◽  
Intermountain West

scholarly journals Clinical characteristics and antimicrobial resistance of pneumococcal isolates of pediatric invasive pneumococcal disease in China

2018 ◽  
Vol Volume 11 ◽  
pp. 2461-2469 ◽  
Author(s):  
Kang Cai ◽  
Yizhong Wang ◽  
Zhongqin Guo ◽  
Xiaonan Xu ◽  
Huajun Li ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Invasive Pneumococcal Disease ◽  
Clinical Characteristics ◽  
Pneumococcal Disease

scholarly journals Evaluating post-vaccine expansion patterns of pneumococcal serotypes

2020 ◽  
Author(s):  
Maile T. Phillips ◽  
Joshua L. Warren ◽  
Noga Givon-Lavi ◽  
Adrienn Tothpal ◽  
Gili Regev-Yochay ◽  
...  
Keyword(s):  
Streptococcus Pneumoniae ◽  
Invasive Pneumococcal Disease ◽  
Jewish Population ◽  
Pneumococcal Disease ◽  
Pneumococcal Serotypes ◽  
Conjugate Vaccines ◽  
Pneumococcal Conjugate Vaccines ◽  
Vaccine Serotypes ◽  
Serotype Replacement ◽  
Disease Understanding

ABSTRACTStreptococcus pneumoniae remains a leading cause of morbidity and mortality. Pneumococcal conjugate vaccines (PCVs) are effective but target only a fraction of the more than 90 pneumococcal serotypes. As a result, the introduction of PCVs has been followed by the emergence of non-vaccine serotypes. With higher-valency PCVs currently under development, there is a need to understand and predict patterns of serotype replacement to anticipate future changes. In this study, we evaluated patterns of change in serotype prevalence post-PCV introduction in Israel. We found that the assumption that non-vaccine serotypes increase by the same proportion overestimates changes in serotype prevalence in Jewish and Bedouin children. Furthermore, pre-vaccine prevalence was positively associated with increases in prevalence over the study period. From our analyses, serotypes 12F, 8, 16F, 33F, 9N, 7B, 10A, 22F, 24F, and 17F were estimated to have gained the most cases of invasive pneumococcal disease through serotype replacement in the Jewish population. However, this model also failed to quantify some additional cases gained, suggesting that changes in carriage in children alone may be insufficient to explain serotype replacement in disease. Understanding of serotype replacement is important as higher-valency vaccines are introduced.

scholarly journals Invasive isolates of Streptococcus pneumoniae in Serbia: Antimicrobial susceptibility and serotypes

2013 ◽  
Vol 141 (1-2) ◽  
pp. 48-53 ◽  
Author(s):  
Ina Gajic ◽  
Vera Mijac ◽  
Lazar Ranin ◽  
Dragana Andjelkovic ◽  
Miroslava Radicevic ◽  
...  
Keyword(s):  
Streptococcus Pneumoniae ◽  
Invasive Pneumococcal Disease ◽  
Antimicrobial Susceptibility ◽  
Pneumococcal Disease ◽  
Medical Problem ◽  
Resistance Rate ◽  
Reference Laboratory ◽  
Susceptibility Pattern ◽  
Antimicrobial Susceptibility Pattern ◽  
Resistance Rates

Introduction. Streptococcus pneumoniae is one of the leading causes of bacterial meningitis and sepsis. Invasive pneumococcal disease is a significant medical problem worldwide, particularly in children, due to a huge increase of pneumococcal resistance to antibiotics. Objective. The aim of the study was to investigate the antimicrobial susceptibility pattern of invasive pneumococcal isolates, as well as to determine whether decreased S. pneumoniae susceptibility to antibiotics was related to a particular serotype. Methods. Antimicrobial susceptibility to 19 antibiotics was determined in 58 invasive pneumococcal strains that were collected from seven regional centers during the period July 2009 to February 2011 in the National Reference Laboratory for streptococci and pneumococci. Results. The overall nonsusceptibility rate to penicillin was detected in 34% of pneumococcal isolates and to erythromycin in 36%. Higher resistance rates were observed among children than among adults. Penicillin resistance rate was 65% in children versus 22% in adults, while erythromycin nonsusceptibility rate was 47% in children versus 32% in adults. Co-resistance to penicillin and erythromycin was detected in 21% strains, mostly isolated from children. Multiresistance was found in one third of isolates. All strains were susceptible to vancomycin, linezolid, fluoroquinolones, telithromycin and rifampicin, while 23 (40%) isolates were susceptible to all tested antibiotics. The most common resistant serotypes were 19F and 14. Conclusion. The study has revealed that penicillin and macrolide resistance among invasive pneumococcal isolates is very high in Serbia. This emphasizes the need for continuous monitoring for invasive pneumococcal disease to document the serotype distribution and antimicrobial susceptibility pattern.

scholarly journals Clinical Characteristics, Risk Factors and Predictive Value of COVID-19 Pneumonia: A Retrospective Study of 173 Patients in Wuhan, China

2020 ◽  
Author(s):  
Yang Zhang ◽  
Jun Xue ◽  
Mi Yan ◽  
Jing Chen ◽  
Hai Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Predictive Model ◽  
Disease Severity ◽  
Roc Curve ◽  
Predictive Value ◽  
Older Patients ◽  
Clinical Characteristics ◽  
Lactic Dehydrogenase ◽  
Older Age ◽  
Hospital Outcome

Abstract Background: COVID-19 is a globally emerging infectious disease. As the global epidemic continues to spread, the risk of COVID-19 transmission and diffusion in the world will also remain. Currently, several studies describing its clinical characteristics have focused on the initial outbreak, but rarely to the later stage. Here we described clinical characteristics, risk factors for disease severity and in-hospital outcome in patients with COVID-19 pneumonia from Wuhan. Methods: Patients with COVID-19 pneumonia admitted to Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from February 13 to March 8, 2020, were retrospectively enrolled. Multivariable logistic regression analysis was used to identify risk factors for disease severity and in-hospital outcome and establish predictive models. Receiver operating characteristic (ROC) curve was used to assess the predictive value of above models.Results: 106 (61.3%) of the patients were female. The mean age of study populations was 62.0 years, of whom 73 (42.2%) had underlying comorbidities mainly including hypertension (24.9%). The most common symptoms on admission were fever (67.6%) and cough (60.1%), digestive symptoms (22.0%) was also very common. Older age (OR: 3.420; 95%Cl: 1.415-8.266; P=0.006), diarrhea (OR: 0.143; 95%Cl: 0.033-0.611; P=0.009) and lymphopenia (OR: 4.769; 95%Cl: 2.019-11.266; P=0.000) were associated with severe illness on admission; the area under the ROC curve (AUC) of predictive model were 0.860 (95%CI: 0.802-0.918; P=0.000). Older age (OR: 0.309; 95%Cl: 0.142-0.674; P=0.003), leucopenia (OR: 0.165; 95%Cl: 0.034-0.793; P=0.025), increased lactic dehydrogenase (OR: 0.257; 95%Cl: 0.100-0.659; P=0.005) and interleukins-6 levels (OR: 0.294; 95%Cl: 0.099-0.872; P=0.027) were associated with poor in-hospital outcome; AUC of predictive model were 0.752 (95%CI: 0.681-0.824; P=0.000).Conclusion: Older patients with diarrhea and lymphopenia need early identification and timely intervention to prevent the progression to severe COVID-19 pneumonia. However, older patients with leucopenia, increased lactic dehydrogenase and interleukins-6 levels are at a high risk for poor in-hospital outcome.Trial registration: ChiCTR2000029549

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