scholarly journals Nasopharyngeal Carriage of Methicillin-Resistant Staphylococcus aureus (MRSA) among Sickle Cell Disease (SCD) Children in the Pneumococcal Conjugate Vaccine Era

2021 ◽  
Vol 13 (1) ◽  
pp. 191-204
Author(s):  
Nicholas T. K. D. Dayie ◽  
Deborah N. K. Sekoh ◽  
Fleischer C. N. Kotey ◽  
Beverly Egyir ◽  
Patience B. Tetteh-Quarcoo ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Sickle Cell Disease ◽  
Conjugate Vaccine ◽  
Sickle Cell ◽  
Pneumococcal Conjugate Vaccine ◽  
Diffusion Method ◽  
Nasopharyngeal Carriage ◽  
Cell Disease ◽  
Coagulase Negative Staphylococci ◽  
Methicillin Resistant

The aim of this cross-sectional study was to investigate Staphylococcus aureus nasopharyngeal carriage epidemiology in relation to other nasopharyngeal bacterial colonizers among sickle cell disease (SCD) children about five years into pneumococcal conjugate vaccine 13 (PCV-13) introduction in Ghana. The study involved bacteriological culture of nasopharyngeal swabs obtained from 202 SCD children recruited from the Princess Marie Louise Children’s Hospital. S. aureus isolates were identified using standard methods and subjected to antimicrobial susceptibility testing using the Kirby-Bauer disc diffusion method. Cefoxitin-resistant S. aureus isolates were screened for carriage of the mecA, pvl, and tsst-1 genes using multiplex polymerase chain reaction. The carriage prevalence of S. aureus was 57.9% (n = 117), and that of methicillin-resistant S. aureus (MRSA) was 3.5% (n = 7). Carriage of the mecA, pvl, and tsst-1 genes were respectively demonstrated in 20.0% (n = 7), 85.7% (n = 30), and 11.4% (n = 4) of the cefoxitin-resistant S. aureus isolates. PCV-13 vaccination (OR = 0.356, p = 0.004) and colonization with coagulase-negative staphylococci (CoNS) (OR = 0.044, p < 0.0001) each protected against S. aureus carriage. However, none of these and other features of the participants emerged as a determinant of MRSA carriage. The following antimicrobial resistance rates were observed in MRSA compared to methicillin-sensitive S. aureus: clindamycin (28.6% vs. 4.3%), erythromycin (42.9% vs. 19.1%), tetracycline (100% vs. 42.6%), teicoplanin (14.3% vs. 2.6%), penicillin (100% vs. 99.1%), amoxiclav (28.6% vs. 3.5%), linezolid (14.3% vs. 0.0%), ciprofloxacin (42.9% vs. 13.9%), and gentamicin (42.9% vs. 13.0%). The proportion of S. aureus isolates that were multidrug resistant was 37.7% (n = 46). It is concluded that S. aureus was the predominant colonizer of the nasopharynx of the SCD children, warranting the continuous monitoring of this risk group for invasive S. aureus infections.

scholarly journals Prevalence of Severe Bacterial Infection in Febrile Children with Sickle CELL Disease in the Era of Pneumococcal Conjugate Vaccine 13

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 3665-3665
Author(s):  
Gloria Contreras-Yametti ◽  
Custodio Haidee ◽  
Hamayun Imran
Keyword(s):  
Sickle Cell Disease ◽  
Conjugate Vaccine ◽  
Sickle Cell ◽  
Pneumococcal Conjugate Vaccine ◽  
Univariate Analysis ◽  
Cell Disease ◽  
Pneumococcal Infections ◽  
Patient Disposition ◽  
Penicillin Prophylaxis ◽  
Febrile Events

Abstract Introduction The incidence of invasive pneumococcal infections in patients with sickle cell disease (SCD) decreased after introduction of penicillin prophylaxis and pneumococcal conjugate vaccine (PCV). However, the decrease in pneumococcal infections alone may not necessarily mean an overall decrease in severe bacterial infections (SBI). In a previous publication, we reported a 0.4 % prevalence of pneumococcal bacteremia following introduction of PCV 13. In the current study, we aimed to define the prevalence of SBI and hospitalization in febrile patients in the same cohort in the later years. Methods We performed a retrospective study of patients with SCD <18 years old presenting with fever to University of South Alabama Children's and Women's Hospital from January 2014 to June 2017. SBI was defined as: bacteremia, pneumonia, pyelonephritis, meningitis, osteomyelitis and abscess (superficial and deep). Univariate analysis and multivariate logistic regression were used to determine factors associated with patient disposition as well as presence of SBI. Results There were 258 febrile events in 120 patients resulting in 187 (72%) admissions (figure 1). SBI was seen in 12% of admissions with uncomplicated community acquired pneumonia being the most common. The prevalence of bacteremia was 1.6% with single cases of pneumococcus, E. coli, and H. influenzae bacteremia. Younger age, high fever, and splenectomy were associated with hospitalization (p<0.05). However, only C reactive protein was associated with SBI (p<0.02). Viral infection was diagnosed in 80% of outpatients but 87% were given antibiotics. Among inpatients, all received parenteral antibiotics, and 67% were assessed to have viral illness, although only 23% had a virus identified. Pneumococcal vaccination status was satisfactory in 77% of our sample while compliance rate with penicillin prophylaxis was >85% in both inpatient and outpatient groups. Conclusion Although majority of febrile events were due to viral infections, 3 of four febrile episodes in our cohort resulted in hospitalization. A small proportion of patients had SBI and a much smaller proportion had bacteremia. These findings support early virus identification which can have implications on patient discharge disposition and antibiotic use. Further studies looking at risk stratification of febrile patients with SCD are needed to encourage outpatient management without compromising safety. Figure 1. Figure 1. Disclosures Imran: Novo Nordask: Speakers Bureau.

Prevalence of Pneumococcal Bacteremia in Children with Sickle Cell Disease Hospitalized for Management of a Febrile Illness

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3214-3214
Author(s):  
Ami P Patel ◽  
Amra Zuzo ◽  
Hamayun Imran ◽  
Abdul H Siddiqui
Keyword(s):  
Sickle Cell Disease ◽  
Conjugate Vaccine ◽  
Sickle Cell ◽  
Pneumococcal Conjugate Vaccine ◽  
Febrile Illness ◽  
Blood Cultures ◽  
Cell Disease ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Pneumococcal Bacteremia

Abstract Abstract 3214 Introduction: Children with sickle cell disease are at a high risk of death from pneumococcal bacteremia due to functional asplenia. The common practice for management of any fever in a child with sickle cell disease is in-patient antibiotic therapy for presumed bacteremia, until the blood cultures have remained negative for 48 hours. We hypothesize that interventions such as penicillin prophylaxis, use of polyvalent pneumococcal vaccine at 2 years of age in addition to the primary immunization series with pneumococcal conjugate vaccine 13 have decreased the prevalence of pneumococcal bacteremia in children with sickle cell disease. Outpatient management of an uncomplicated febrile illness may be a safe alternative. Methods: We conducted a retrospective chart review of children with sickle cell disease hospitalized with a fever at Children's and Women's Hospital between January 2006 and June 2012. We collected demographical parameters, temperature, white blood cell count and C-reactive protein level at the time of presentation as possible predictors of true bacteremia. The continuous variables were compared between the two groups (positive and negative blood cultures) using independent t-test. We also recorded the time to positivity of blood cultures, pathogens identified in positive blood cultures, serotypes and sensitivities of pneumococcal bacteria. Results: A total of 133 patients, aged 2 months to 18 years, met the inclusion criteria with 456 hospital admissions. The prevalence of culture proven bacteremia was 3.7% with only two (0.44%) cases of pneumococcal bacteremia. We have not had any patient with pneumococcal bacteremia reported since the start of pneumococcal conjugate vaccine 13, in May 2010. Both the patients with pneumococcal bacteremia were older than five years and had discontinued taking penicillin prophylaxis. The first patient was fully vaccinated with pneumococcal conjugate vaccine 7 but had not received polyvalent vaccine. She contracted a non-vaccine serotype (23B) that was susceptible to penicillin, ceftriaxone, and vancomycin. The second patient was partially vaccinated and acquired a serotype (23F) that is included in pneumococcal conjugate vaccine 7. The bacterium was resistant to penicillin but sensitive to ceftriaxone and vancomycin. In the analysis of predictors of bacteremia, the average C-reactive protein level was found to be 6.3mg/dL in patients with positive blood cultures and 4.5mg/dL in patients with negative blood cultures (p=0.02). The mean age of patients with positive blood cultures was 11 years compared to 7.4 years in patients with negative blood cultures (p=0.03). The differences in body temperature and white blood cell count between the two groups were not statistically significant. The average time to positivity measured from the time of collection was 25.4 hours. Discussion: Penicillin prophylaxis and complete immunization, in accordance with the centers for disease control and prevention guidelines are important for patients with sickle cell disease. Patients with an uncomplicated febrile illness may not necessarily need to be hospitalized to continue antibiotics. We support an outpatient care model proposed by Williams et al, comprising of a single 24-hour dose of ceftriaxone followed by oral cefixime for 5 days and follow-up telephone calls by a nurse. Good patient education may help ensure compliance with outpatient care. Outpatient management of an uncomplicated febrile illness will be more cost-effective and beneficial to the patients and families. With this approach, however, patients may not be fully protected against ceftriaxone resistant pneumococccal infections. Bacterial resistance patterns in the community should be brought under consideration when implementing such a model. Conclusion: The prevalence of pneumococcal bacteremia in children with sickle cell disease has decreased in the past few years. In our analyses, we found older age and an elevated C-reactive protein level to be statistically significant predictors of a positive blood culture. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Penicillin Resistance in Nasopharyngeal <i>Streptococcus pneumoniae</i> among Children with Sickle Cell Disease Immunized with 7-Valent Pneumococcal Conjugate Vaccine

2013 ◽  
Vol 03 (02) ◽  
pp. 25-31 ◽  
Author(s):  
Patricia Belintani Blum Fonseca ◽  
Calil Kairalla Farhat ◽  
Regina Célia de Menezes Succi ◽  
Antônia Maria de Oliveira Machado ◽  
Josefina Aparecida Pellegrini Braga
Keyword(s):  
Streptococcus Pneumoniae ◽  
Sickle Cell Disease ◽  
Conjugate Vaccine ◽  
Sickle Cell ◽  
Pneumococcal Conjugate Vaccine ◽  
Penicillin Resistance ◽  
Cell Disease
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