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Ho PL, Law PYT, Chiu SS. Increase in incidence of invasive pneumococcal disease caused by serotype 3 in children eight years after the introduction of the pneumococcal conjugate vaccine in Hong Kong. Hum Vaccin Immunother 2018; 15:455-458. [PMID: 30261157 DOI: 10.1080/21645515.2018.1526555] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
This study used several datasets of reported and serotyped invasive pneumococcal disease (IPD) cases to estimate vaccine and non-vaccine type incidence in Hong Kong children. Incidence was analyzed by four time periods to indicate pre-PCV (period 1, 1995-2004), private market only (period 2, 2006-2009), and following early (period 3, 2010-2014, mixed use of 7-, 10- and 13-valent vaccines) and more than five years (period 4, 2015-2017, 13-valent vaccine only) of routine implementation (since September 2009). IPD incidence decreased by 85% and 35% in aged < 2 years and aged 2 to < 5 years, respectively, from period 1 to period 4. This was due to a 97% reduction in the serotypes covered by 7-valent vaccine. In period 4, 59% of the disease was caused by serotype 3 and was largely attributed to an ermB positive, novel ST6011 clone. The finding corroborates an increasing body of evidence that the efficacy of the 13-valent vaccine against infection by this serotype is low.
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Affiliation(s)
- Pak-Leung Ho
- a Department of Microbiology , University of Hong Kong , Hong Kong SAR , China
| | | | - Susan S Chiu
- b Department of Paediatrics and Adolescent Medicine , University of Hong Kong , Hong Kong SAR , China
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Kim JH, Baik SH, Chun BC, Song JY, Bae IG, Kim HY, Kim DM, Choi YH, Choi WS, Jo YM, Kwon HH, Jeong HW, Kim YS, Kim JY, Lee J, Kee SY, Hur J, Chung JW, Hwang KE, Kim MJ. Adult invasive pneumococcal disease in the Republic of Korea: Risk medical conditions and mortality stratified by age group. Int J Infect Dis 2018; 74:136-144. [PMID: 30055332 DOI: 10.1016/j.ijid.2018.07.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/18/2018] [Accepted: 07/19/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES This study aimed to characterize the risk factors for mortality in adult patients with invasive pneumococcal disease (IPD) stratified by age groups, after implementation of the national immunization program of 23-valent polysaccharide vaccine (PPSV23) for those aged ≥65 years in the Republic of Korea (ROK). METHODS Clinical data and pneumococcal isolates from adult patients with IPD (≥18 years of age) were collected prospectively from 20 hospitals through the nationwide surveillance program from March 2013 to October 2015. RESULTS A total of 319 patients with IPD were enrolled. Median age was 69 years. Overall in-hospital mortality was 34.2%: 17.1% in those aged 18-49 years, 23.7% in those aged 50-64 years, 33.0% in those aged 65-74 years, and 51.0% in those aged ≥75 years (p<0.001). In particular, early death within 7days of hospitalization accounted for 60.6% (66/109). While old age (≥65 years), higher Pitt bacteremia score (≥4), and bacteremic pneumonia were independently associated with IPD mortality in all age groups, an additional mortality risk factor of immunocompromised status was identified for patients aged 50-64 years. PPSV23 serotypes accounted for 64.4% (122/189) of the pneumococcal isolates serotyped. CONCLUSIONS This study suggests that vaccine-type IPD continues to place a substantial burden on older adults in the ROK, necessitating an effective vaccination strategy for those at higher risk.
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Affiliation(s)
- Jong Hun Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Seung Hee Baik
- Department of Internal Medicine, Cheju Halla General Hospital, Jeju-si, Republic of Korea
| | - Byung Chul Chun
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Joon Young Song
- Division of Infectious Diseases, Department of Internal Medicine, Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - In-Gyu Bae
- Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Hyo Youl Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Dong-Min Kim
- Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Young Hwa Choi
- Department of Internal Medicine, Ajou University Hospital, Suwon, Republic of Korea
| | - Won Suk Choi
- Division of Infectious Diseases, Department of Internal Medicine, Ansan Hospital, College of Medicine, Korea University, Ansan, Gyeonggi-do, Republic of Korea
| | - Yu Mi Jo
- Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Hyun Hee Kwon
- Department of Internal Medicine, Daegu Catholic University, Daegu, Republic of Korea
| | - Hye Won Jeong
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, Chungcheongbuk-do, Republic of Korea
| | - Yeon-Sook Kim
- Division of Infectious Diseases, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Jeong Yeon Kim
- Division of Infectious Diseases, Department of Internal Medicine, Sahmyook Medical Center, Seoul, Republic of Korea
| | - Jacob Lee
- Division of Infectious Diseases, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Sae Yoon Kee
- Division of Infectious Diseases, Department of Internal Medicine, Konkuk University Chungju Hospital, Chungju, Republic of Korea
| | - Jian Hur
- Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Jin Won Chung
- Division of Infectious Diseases, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Ki-Eun Hwang
- Department of Internal Medicine, School of Medicine, Wonkwang University, Iksan, Republic of Korea
| | - Min Ja Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea; The Research Institute of Emerging Infectious Diseases, Korea University, Seoul, Republic of Korea.
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Cheng VCC, Wong SCY, Ho PL, Yuen KY. Strategic measures for the control of surging antimicrobial resistance in Hong Kong and mainland of China. Emerg Microbes Infect 2015; 4:e8. [PMID: 26038766 PMCID: PMC4345289 DOI: 10.1038/emi.2015.8] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 12/30/2014] [Accepted: 12/30/2014] [Indexed: 01/23/2023]
Abstract
Antimicrobial-resistant bacteria are either highly prevalent or increasing rapidly in Hong Kong and China. Treatment options for these bacteria are generally limited, less effective and more expensive. The emergence and dynamics of antimicrobial resistance genes in bacteria circulating between animals, the environment and humans are not entirely known. Nonetheless, selective pressure by antibiotics on the microbiomes of animal and human, and their associated environments (especially farms and healthcare institutions), sewage systems and soil are likely to confer survival advantages upon bacteria with antimicrobial-resistance genes, which may be further disseminated through plasmids or transposons with integrons. Therefore, antibiotic use must be tightly regulated to eliminate such selective pressure, including the illegalization of antibiotics as growth promoters in animal feed and regulation of antibiotic use in veterinary practice and human medicine. Heightened awareness of infection control measures to reduce the risk of acquiring resistant bacteria is essential, especially during antimicrobial use or institutionalization in healthcare facilities. The transmission cycle must be interrupted by proper hand hygiene, environmental cleaning, avoidance of undercooked or raw food and compliance with infection control measures by healthcare workers, visitors and patients, especially during treatment with antibiotics. In addition to these routine measures, proactive microbiological screening of hospitalized patients with risk factors for carrying resistant bacteria, including history of travel to endemic countries, transfer from other hospitals, and prolonged hospitalization; directly observed hand hygiene before oral intake of drugs, food and drinks; and targeted disinfection of high-touch or mutual-touch items, such as bed rails and bed curtains, are important. Transparency of surveillance data from each institute for public scrutiny provides an incentive for controlling antimicrobial resistance in healthcare settings at an administrative level.
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Affiliation(s)
- Vincent C C Cheng
- Department of Microbiology, Queen Mary Hospital , Hong Kong, China ; Infection Control Team, Queen Mary Hospital , Hong Kong, China
| | - Sally C Y Wong
- Department of Microbiology, Queen Mary Hospital , Hong Kong, China
| | - Pak-Leung Ho
- Department of Microbiology, Queen Mary Hospital , Hong Kong, China
| | - Kwok-Yung Yuen
- Department of Microbiology, Queen Mary Hospital, Hong Kong, China ; Department of Clinical Microbiology and Infection Control, Hong Kong University-Shenzhen Hospital , Shenzhen 518053, Guangdong province, China
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Overview of community-acquired pneumonia and the role of inflammatory mechanisms in the immunopathogenesis of severe pneumococcal disease. Mediators Inflamm 2013; 2013:490346. [PMID: 24453422 PMCID: PMC3886318 DOI: 10.1155/2013/490346] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 11/15/2013] [Accepted: 11/17/2013] [Indexed: 12/23/2022] Open
Abstract
Community-acquired pneumonia (CAP) remains a leading cause of morbidity and mortality among the infectious diseases. Despite the implementation of national pneumococcal polyvalent vaccine-based immunisation strategies targeted at high-risk groups, Streptococcus pneumoniae (the pneumococcus) remains the most common cause of CAP. Notwithstanding the HIV pandemic, major challenges confronting the control of CAP include the range of bacterial and viral pathogens causing this condition, the ever-increasing problem of antibiotic resistance worldwide, and increased vulnerability associated with steadily aging populations in developed countries. These and other risk factors, as well as diagnostic strategies, are covered in the first section of this review. Thereafter, the review is focused on the pneumococcus, specifically the major virulence factors of this microbial pathogen and their role in triggering overexuberant inflammatory responses which contribute to the immunopathogenesis of invasive disease. The final section of the review is devoted to a consideration of pharmacological, anti-inflammatory strategies with adjunctive potential in the antimicrobial chemotherapy of CAP. This is focused on macrolides, corticosteroids, and statins with respect to their modes of anti-inflammatory action, current status, and limitations.
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Suzuki H, Shichi D, Tokuda Y, Ishikawa H, Maeno T, Nakamura H. Pneumococcal vertebral osteomyelitis at three teaching hospitals in Japan, 2003-2011: analysis of 14 cases and a review of the literature. BMC Infect Dis 2013; 13:525. [PMID: 24209735 PMCID: PMC3833677 DOI: 10.1186/1471-2334-13-525] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 11/04/2013] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Pneumococcal vertebral osteomyelitis (PVO) is a rare disease whose clinical characteristics have not been clarified. This study aimed to investigate the clinical features and outcomes of patients with PVO. METHODS We retrospectively evaluated all adult patients diagnosed with PVO at three teaching hospitals in Japan from January 2003 to December 2011. All cases were identified through a review of the medical records of patients with invasive pneumococcal disease (IPD). RESULTS Among 208 patients with IPD, we identified 14 with PVO (6.4%; 95% CI, 3.5-10%). All 14 patients (nine male, five female; median age 69 years) had acquired PVO outside the hospital and had no recent history of an invasive procedure or back injury. Five patients (36%) had diabetes mellitus, and four (29%) had heavy alcohol intake. Fever (n = 13; 93%) or back pain/neck pain (n = 12; 86%) were present in most patients. The lumbar spine was affected in nine patients (64%) but the cervical spine was the site of infection in four patients (29%). All patients except one had a positive blood culture for Streptococcus pneumoniae, and there were no distant infected sites in most patients (n = 10; 71%). Intravenous beta-lactam therapy was initiated within 1 week after the onset of symptoms in 11 patients (79%). No patients died within 30 days, but one patient died from aspiration pneumonia on day 37 after admission. CONCLUSIONS PVO was relatively common among adult patients with IPD, and mortality was low in this study. S. pneumoniae may be the causative pathogen of vertebral osteomyelitis, especially among community-onset cases without a history of invasive procedures or back injury.
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Affiliation(s)
- Hiromichi Suzuki
- Department of Clinical Laboratory Medicine, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, Tsukuba 305-8558, Japan.
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Ma X, Zhao R, Ma Z, Yao K, Yu S, Zheng Y, Yang Y. Serotype distribution and antimicrobial resistance of Streptococcus pneumoniae isolates causing invasive diseases from Shenzhen Children's Hospital. PLoS One 2013; 8:e67507. [PMID: 23840728 PMCID: PMC3696094 DOI: 10.1371/journal.pone.0067507] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Accepted: 05/19/2013] [Indexed: 11/18/2022] Open
Abstract
Objective To provide guidance for clinical disease prevention and treatment, this study examined the epidemiology, antibiotic susceptibility, and serotype distribution of Streptococcus pneumoniae (S. pneumoniae) associated with invasive pneumococcal diseases (IPDs) among children less than 14 years of age in Shenzhen, China. Materials and Methods All the clinical strains were isolated from children less than 14 years old from January 2009 to August 2012. The serotypes and antibiotic resistance of strains of S. pneumoniae were determined using the capsular swelling method and the E-test. Results A total of 89 strains were isolated and 87 isolates were included. The five prevailing serotypes were 19F (28.7%), 14 (16.1%), 23F (11.5%), 19A (9.2%) and 6B (6.9%). The most common sequence types (ST) were ST271 (21.8%), ST876 (18.4%), ST320 (8.0%) and ST81 (6.9%) which were mainly related to 19F, 14, 19A and 23F, respectively. The potential coverage by 7-, 10-, and 13-valent pneumococcal conjugate vaccine were 77.0%, 77.0%, and 89.7%, respectively. Among the 87 isolates investigated, 11.5% were resistant to penicillin, and for meningitis isolates, the resistance rate was 100%. Multi-drug resistance (MDR) was exhibited by 49 (56.3%) isolates. Eighty-four isolates were resistance to erythromycin, among which, 56 (66.7%) carried the ermB gene alone and 28 (33.3%) expressed both the ermB and mefA/E genes. Conclusions The potential coverage of PCV13 is higher than PCV7 and PCV10 because high rates of serotypes 19A and 6A in Shenzhen. The clinical treatment of IPD needs a higher drug concentration of antibiotics. Continued surveillance of the antimicrobial susceptibility and serotypes distribution of IPD isolates may be necessary.
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Affiliation(s)
- Xiang Ma
- Key Laboratory of Major Diseases in Children and National Key Discipline of Pediatrics (Capital Medical University), Ministry of Education, Beijing Pediatrics Research Institute, Beijing Children’s Hospital Affiliated to Capital Medical University, Beijing, China
| | - Ruizhen Zhao
- Laboratory of Bacteriology and Department of Respiratory Diseases, Shenzhen Children’s Hospital, Shenzhen, China
| | - Zhuoya Ma
- Laboratory of Bacteriology and Department of Respiratory Diseases, Shenzhen Children’s Hospital, Shenzhen, China
| | - Kaihu Yao
- Key Laboratory of Major Diseases in Children and National Key Discipline of Pediatrics (Capital Medical University), Ministry of Education, Beijing Pediatrics Research Institute, Beijing Children’s Hospital Affiliated to Capital Medical University, Beijing, China
| | - Sangjie Yu
- Key Laboratory of Major Diseases in Children and National Key Discipline of Pediatrics (Capital Medical University), Ministry of Education, Beijing Pediatrics Research Institute, Beijing Children’s Hospital Affiliated to Capital Medical University, Beijing, China
| | - Yuejie Zheng
- Laboratory of Bacteriology and Department of Respiratory Diseases, Shenzhen Children’s Hospital, Shenzhen, China
- * E-mail: (YY); (YZ)
| | - Yonghong Yang
- Key Laboratory of Major Diseases in Children and National Key Discipline of Pediatrics (Capital Medical University), Ministry of Education, Beijing Pediatrics Research Institute, Beijing Children’s Hospital Affiliated to Capital Medical University, Beijing, China
- * E-mail: (YY); (YZ)
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Direct bacterial identification in positive blood cultures by use of two commercial matrix-assisted laser desorption ionization-time of flight mass spectrometry systems. J Clin Microbiol 2013; 51:1733-9. [PMID: 23515548 DOI: 10.1128/jcm.03259-12] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) for the identification of bacteria and fungi was recently introduced in microbiology laboratories. This technology could greatly improve the clinical management of patients and guidance for chemotherapy. In this study, we used a commercial MALDI Sepsityper extraction method to evaluate the performance of two commercial MALDI-TOF MS systems, the Vitek MS IVD (bioMérieux) and the Microflex LT Biotyper (Bruker Daltonics) for direct bacterial identification in positive blood cultures. In 181 monomicrobial cultures, both systems generated genus to species level identifications for >90% of the specimens (Biotyper, 177/181 [97.8%]; Vitek MS IVD, 167/181 [92.3%]). Overall, the Biotyper system generated significantly more accurate identifications than the Vitek MS IVD system (P = 0.016; 177 versus 167 out of 181 specimens). The Biotyper system identified the minority species among polymicrobial blood cultures. We also compared the performance of an in-house extraction method with that of the Sepsityper on both MALDI-TOF MS systems. The in-house method generated more correct identifications at the genus level than the Sepsityper (96.7% versus 93.5%) on the Biotyper system, whereas the two methods exhibited the same performance level (88.0% versus 88.0%) on the Vitek MS IVD system. Our study confirmed the practical advantages of MALDI-TOF MS, and our in-house extraction method reduced the reagent cost to $1 per specimen, with a shorter turnaround time of 3 h, which is highly cost-effective for a diagnostic microbiology service.
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Hung IFN, Tantawichien T, Tsai YH, Patil S, Zotomayor R. Regional epidemiology of invasive pneumococcal disease in Asian adults: epidemiology, disease burden, serotype distribution, and antimicrobial resistance patterns and prevention. Int J Infect Dis 2013; 17:e364-73. [PMID: 23416209 DOI: 10.1016/j.ijid.2013.01.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 01/05/2013] [Accepted: 01/08/2013] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To summarize published data on the clinical and economic burden, epidemiology, antimicrobial resistance levels, serotype prevalence, and prevention strategies for pneumococcal disease among adults in Asia. METHODS We performed a systematic search of the PubMed database for relevant, peer-reviewed articles published between January 1995 and December 2011, covering China, Hong Kong, India, Indonesia, Japan, Malaysia, Pakistan, the Philippines, Singapore, South Korea, Taiwan, Thailand, and Vietnam. RESULTS Taiwan and Thailand had the most comprehensive epidemiological data on adult pneumococcal disease. Very little relevant data were found for Indonesia, Pakistan, the Philippines, and Vietnam; surveillance is urgently needed in these countries. The emergence and spread of resistance emphasize the importance of vaccination to prevent infection in adults at increased risk for serious pneumococcal disease. Vaccination policies and opinions on the efficacy of vaccination vary widely in Asian countries, although a new option in the form of a pneumococcal conjugate vaccine is now available. CONCLUSIONS Increased awareness of the public health and economic benefits of pneumococcal vaccination is critically needed to help both the public and policymakers in making changes to vaccination policies in the region. Maximizing access to pneumococcal vaccines will decrease the number of hospitalizations, complications, and deaths associated with pneumococcal disease.
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Affiliation(s)
- Ivan Fan-Ngai Hung
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong.
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Nakazawa K, Kanemoto K, Suzuki H, Masuda M, Matsuno Y, Iijima H, Ishikawa H. Purulent pericarditis with concurrent detection of Streptococcus pneumoniae and malignant squamous cells in pericardial fluid. Intern Med 2013; 52:1413-6. [PMID: 23774558 DOI: 10.2169/internalmedicine.52.9411] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Pneumococcal pericarditis complicated by a malignant effusion has not been reported previously. We experienced an independent 62-year-old man with lung cancer who was hospitalized for acute onset of atrial flutter and moderate pericardial effusion. He was afebrile; however, pericardiocentesis showed Streptococcus pneumoniae and malignant squamous cells in purulent pericardial fluid. This case shows that clinicians should keep in mind the possibility of afebrile bacterial pericarditis in cancer patients with pericardial effusions and that cultures of pericardial fluid should be performed in such patients along with cytological examinations.
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Affiliation(s)
- Kensuke Nakazawa
- Department of Respiratory Medicine, Tsukuba Medical Center Hospital, Japan
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Suzuki H, Tokuda Y, Shichi D, Ishikawa H, Maeno T, Nakamura H. Morbidity and mortality among newly hospitalized patients with community-acquired pneumococcal bacteremia: A retrospective cohort study in three teaching hospitals in Japan. Geriatr Gerontol Int 2012; 13:607-15. [DOI: 10.1111/j.1447-0594.2012.00949.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Impact of penicillin nonsusceptibility on clinical outcomes of patients with nonmeningeal Streptococcus pneumoniae bacteremia in the era of the 2008 clinical and laboratory standards institute penicillin breakpoints. Antimicrob Agents Chemother 2012; 56:4650-5. [PMID: 22687517 DOI: 10.1128/aac.00239-12] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
To investigate the impact of penicillin nonsusceptibility on clinical outcomes of patients with nonmeningeal Streptococcus pneumoniae bacteremia (SPB), a retrospective cohort study was performed. The characteristics of 39 patients with penicillin-nonsusceptible SPB (PNSPB) were compared to those of a group of age- and sex-matched patients (n = 78) with penicillin-susceptible SPB (PSSPB). Susceptibility to penicillin was redetermined by using the revised Clinical and Laboratory Standards Institute (CLSI) penicillin breakpoints in CLSI document M100-S18. Although the PNSPB group tended to have more serious initial manifestations than the PSSPB group, the two groups did not differ significantly in terms of their 30-day mortality rates (30.8% versus 23.1%; P = 0.37) or the duration of hospital stay (median number of days, 14 versus 12; P = 0.89). Broad-spectrum antimicrobial agents, such as extended-spectrum cephalosporins, vancomycin, and carbapenem, were frequently used in both the PNSPB and PSSPB groups. Multivariate analysis revealed that ceftriaxone nonsusceptibility (adjusted odds ratio [aOR] = 4.88; 95% confidence interval [CI] = 1.07 to 22.27; P = 0.041) was one of the independent risk factors for 30-day mortality. Thus, when the 2008 CLSI penicillin breakpoints are applied and the current clinical practice of using wide-spectrum empirical antimicrobial agents is pursued, fatal outcomes in patients with nonmeningeal SPB that can be attributed to penicillin nonsusceptibility are likely to be rare. Further studies that examine the clinical impact of ceftriaxone nonsusceptibility in nonmningeal SPB may be warranted.
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Ho PL, Chiu SS, Chan MY, Ang I, Chow KH, Lau YL. Changes in nasopharyngeal carriage and serotype distribution of antibiotic-resistant Streptococcus pneumoniae before and after the introduction of 7-valent pneumococcal conjugate vaccine in Hong Kong. Diagn Microbiol Infect Dis 2011; 71:327-34. [DOI: 10.1016/j.diagmicrobio.2011.09.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Revised: 08/30/2011] [Accepted: 09/07/2011] [Indexed: 10/16/2022]
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Giner AM, Kuster SP, Zbinden R, Ruef C, Ledergerber B, Weber R. Initial management of and outcome in patients with pneumococcal bacteremia: a retrospective study at a Swiss university hospital, 2003-2009. Infection 2011; 39:519-26. [PMID: 22065426 DOI: 10.1007/s15010-011-0218-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2011] [Accepted: 07/05/2011] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of this quality control study was to assess the time to initial diagnostic procedures and the time to the first dose of antibiotics in patients with pneumococcal bacteremia, and to investigate whether the timeliness of these interventions influenced outcome. METHODS We retrospectively studied patient characteristics, chronological sequence of diagnostic and therapeutic steps, and the course of disease of all patients with pneumococcal bacteremia at a Swiss university hospital between 2003 and 2009, and we analyzed associations between these factors and the length of hospital stay (LOS) and mortality. RESULTS A total of 102 episodes of pneumococcal bacteremia in 98 patients were analyzed, of whom 15.7% died during hospitalization. The median time (interquartile range [IQR]) to the first antibiotic dose was 4.0 (2.0-5.9) h, and the median times (IQR]) to blood cultures, chest radiograph, lumbar puncture, and brain computed tomography (CT) scan or magnetic resonance imaging (MRI) were 1.4 (0.5-3.3), 2.5 (1.2-4.2), 4.2 (2.7-7.2), and 2.3 (0.6-6.2) h, respectively. The time to diagnostic procedures and therapy were not associated with LOS or death. Risk factors for death in the univariable analysis were: Charlson comorbidity index [odds ratio [OR] (95% confidence interval) per unit increase, 1.3 (1.1-1.6)], neutropenia [OR 10.1 (2.0-51.0)], human immunodeficiency virus (HIV) infection [OR 3.9 (1.1-13.8)], chronic respiratory disease [OR 4.4 (1.2-16.0)], chronic liver disease [OR 3.2 (1.0-9.7)], smoking [OR 3.8 (1.1-13.5)], injection drug use [OR 9.7 (1.5-63.7)], and antibiotic therapy within 6 months before admission [OR 4.0 (1.3-12.5)]. The multivariable analysis revealed age >60 years (P = 0.048) and alcoholism (P = 0.009) as risks for prolonged LOS. CONCLUSIONS The outcome of pneumococcal bacteremia may be more influenced by patient characteristics than by minor differences in the timeliness of initial diagnostic and therapeutic measures within the first several hours after hospital admission.
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Affiliation(s)
- A-M Giner
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.
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Ho PL, Chiu SS, Ang I, Lau YL. Serotypes and antimicrobial susceptibilities of invasive Streptococcus pneumoniae before and after introduction of 7-valent pneumococcal conjugate vaccine, Hong Kong, 1995–2009. Vaccine 2011; 29:3270-5. [DOI: 10.1016/j.vaccine.2011.02.025] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Revised: 02/02/2011] [Accepted: 02/09/2011] [Indexed: 11/25/2022]
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The prevalence and characteristics of Streptococcus pneumoniae isolates expressing serotypes 6C and 6D in Hong Kong prior to the introduction of the 7-valent pneumococcal conjugate vaccine. Diagn Microbiol Infect Dis 2011; 68:439-44. [PMID: 20926218 DOI: 10.1016/j.diagmicrobio.2010.07.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Revised: 07/24/2010] [Accepted: 07/26/2010] [Indexed: 11/23/2022]
Abstract
A study was conducted to determine the prevalence of the 2 newly described types, 6C and 6D, among pneumococcal isolates collected in Hong Kong before availability of the 7-valent pneumococcal conjugate vaccine. A total of 154 serogroup 6 isolates obtained from nasopharynx (n = 106), blood (n = 22), respiratory (n = 24), and cerebrospinal fluid (CSF) (n = 2) during 1995 to 2001 were analyzed by polymerase chain reaction typing. Five nasopharyngeal and 2 sputum isolates were found to belong to 6C and 6D, respectively. The isolates were genetically diverse, but one 6C and two 6D isolates exhibited some clonal relationship. Phylogenetic analysis of the wchA-wciN(β)-wciO nucleotide sequences showed that the Hong Kong 6C/6D isolates had 2 allelic profiles, which were more closely related to 6C/6D isolates from Fijian and Korea than were those from Brazil and the United States. However, all of the wciP gene sequences for both Hong Kong and non-Hong Kong isolates clustered together: 6C isolates with the wciP-9 allele and 6D isolates with the wciP-5 allele. In conclusion, the prevalence of the 2 newly described serotypes was low before the era of the pneumococcal conjugate vaccine. Nonetheless, results from the molecular studies indicated that the evolution of the capsular genes have involved complex pathways.
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Vanhoof R, Camps K, Carpentier M, De Craeye S, Frans J, Glupczynski Y, Goffinet P, Gordts B, Govaerts D, Ide L, Lefèvre P, Lontie M, Cartuyvels R, Meunier F, Mulongo B, Philippart I, Surmont I, Van Bossuyt E, Van Eldere J, Verhaegen J. 10th Survey of antimicrobial resistance in noninvasive clinical isolates of Streptococcus pneumoniae collected in Belgium during winter 2007–2008. ACTA ACUST UNITED AC 2010; 58:147-51. [DOI: 10.1016/j.patbio.2009.07.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Accepted: 07/13/2009] [Indexed: 10/20/2022]
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Ho PL, Cheng VCC, Chu CM. Antibiotic Resistance in Community-Acquired Pneumonia Caused by Streptococcus pneumoniae , Methicillin-Resistant Staphylococcus aureus , and Acinetobacter baumannii. Chest 2009; 136:1119-1127. [DOI: 10.1378/chest.09-0285] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Pottumarthy S, Sader HS, Jones RN. Bactericidal activity of cefepime and ceftriaxone tested against Streptococcus pneumoniae. Diagn Microbiol Infect Dis 2007; 57:345-9. [PMID: 17141459 DOI: 10.1016/j.diagmicrobio.2006.08.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2006] [Accepted: 08/18/2006] [Indexed: 11/21/2022]
Abstract
The bactericidal activities of cefepime and ceftriaxone were assessed by testing a contemporary collection of 50 Streptococcus pneumoniae strains. Minimum inhibitory and bactericidal concentrations (MIC and MBC, respectively) of cefepime and ceftriaxone were determined, and time-kill studies were performed on 14 selected strains (10 penicillin-resistant, 2-intermediate, and 2-susceptible). Cefepime and ceftriaxone showed essentially identical potency (MIC50, 1 microg/mL and MIC90, 2 microg/mL, for both compounds) and MBC values (MBC50, 1 microg/mL for both). MBC/MIC ratios were < or = 4 for cefepime and < or = 8 for ceftriaxone on 48 (96.0%) strains, and 2 strains (4.0%) displayed MBC/MIC ratios > or = 32 (tolerance) to the 2 cephalosporins. Time-kill curves corroborated the MBC/MIC studies. Cefepime and ceftriaxone bactericidal activity (> or = 3 log10 CFU/mL reduction in inoculum) was demonstrable after 24 h of exposure to 8x MIC for 13 (92.9%) of 14 strains, whereas 1 strain showed approximately 2 log10 CFU/mL reduction. In conclusion, our results indicate that cefepime and ceftriaxone exhibit comparable potency and bactericidal activities when tested against contemporary pneumococcal strains with varying penicillin susceptibility patterns. Both parenteral cephems offer alternative therapeutic choices for the treatment of invasive pneumococcal infections.
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Affiliation(s)
- Sudha Pottumarthy
- Houston Department of Health and Human Services, Houston, TX 77054, USA
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