Prevalência de sorotipos e resistência antimicrobiana de cepas invasivas do pneumococo em crianças: análise de 9 anos

Objective: To determine the prevalence of serotypes and antimicrobial susceptibility of strains of pneumococcus in children and to evaluate the implications for vaccine formulation.Methods: Strains of pneumococcus obtained from children admitted with invasive diseases were isolated at Hospital de Clinicas of Universidade Federal de Uberlandia, Uberlandia, Brazil, and sent to Instituto Adolfo Lutz, São Paulo, Brazil, for further identification, serotyping, and determination of antimicrobial susceptibility.Results: From April 1999 to December 2008, 142 strains of pneumococcus, obtained from children under 5 years of age, were analyzed. Seventy-five (52.8%) patients were male, and the age ranged from 1 to 60 months (mean age = 19 +/- 15.4 months; median = 15 months). the most common diagnoses were pneumonia [92 cases (64.8%)] and meningitis [33 cases (23.2%)]. the strains were mostly isolated from blood [61 samples (43%)], pleural fluid [52 samples (36.6%)], and cerebrospinal fluid [28 samples (19.7%)]. the most common serotypes were 14, 5, 6B, 1, 6A, 18C, 19A, 3, 9V, 19F, 23F, 9N, and 10A. There were 14 [9.9%] penicillin-resistant strains, which was detected only in the following serotypes: 14, 6B, 19F, 19A, and 23F, being predominant from 2004 to 2008 (p = 0.000). There was reduced susceptibility to co-trimoxazole (79.5%), erythromycin and clindamycin (11.3% each), and ceftriaxone (5.6%).Conclusions: Penicillin resistance was detected in 9.9% of the strains, being predominant from 2004 to 2008. Twenty different pneumococcal serotypes were identified, and 71.9% of the serotypes were represented in the 7-valent conjugate vaccine (PN CRM7) currently available.Univ Fed Uberlandia, Fac Med, Programa Posgrad Ciencias Saude, BR-38400 Uberlandia, MG, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, São Paulo, BrazilUniv Fed Uberlandia, Lab Hosp Clin Uberlandia, Uberlandia, MG, BrazilUniv São Paulo, Microbiol Clin, São Paulo, BrazilIAL, Secao Bacteriol, Projeto Sistema Reg Vacinas SIREVA, São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, São Paulo, BrazilWeb of Scienc

Prevalência de sorotipos e resistência a antimicrobianos de cepas invasivas do Streptococcus pneumoniae em pacientes com diagnóstico de meningite admitidos em um hospital universitário

The aim of this study was to evaluate the profile of serotypes and antimicrobial resistance of pneumococcal strains obtained from clinical specimens of patients admitted with a diagnosis of meningitis at the Hospital Clinics, Federal University of Uberlandia (HC-UFU). Invasive pneumococcal strains isolated in the Clinical Laboratory of HC-UFU samples from inpatients were identified and sent to Instituto Adolfo Lutz (IAL) in Sao Paulo, SP, to confirm the identification, serotyping and determination of antimicrobial susceptibility. From April 1999 to April 2009, among 338 strains recovered, 72 obtained from patients with meningitis were evaluated. Forty six (63.9%) patients were male and the age ranged from one month to 82.2 years old, mean of 18.4 ± 22.9 years, median of 5.2 years. Strains were isolated from cerebrospinal fluid [66 occasions (91.7%)] and blood [6 occasions (8.3%)]. There were 24 different serotypes of pneumococcus and the most commonly identified were 14, 19F, 3, 7F, 6A, 6B, 10A, 18C, 23F, 5 and 34 giving a figure of coverage by the 7-valent conjugate vaccine of 79.8% and the 10-valent of 91.3 among children aged up to five years. Amongst 20 [27.8%] oxacillin-resistant strains, 17 [23.6%] confirmed resistant to penicillin and nine [12,5%] resistant to ceftriaxone, both being more common in children until 24 months and during the period of 2005 to 2009.Mestre em Ciências da SaúdeO objetivo deste trabalho foi avaliar o perfil dos sorotipos e a resistência a antimicrobianos de cepas de pneumococo obtidas a partir de espécimes clínicos de indivíduos admitidos com diagnóstico de meningite no Hospital de Clinicas da Universidade Federal de Uberlândia (HC-UFU). Cepas invasivas de pneumococo isoladas no Laboratório de Análises Clínicas do HC-UFU a partir de amostras de pacientes internados foram identificadas e enviadas ao Instituto Adolfo Lutz (IAL), em São Paulo, SP, para confirmação da identificação, sorotipagem e determinação da sensibilidade aos antimicrobianos. De abril de 1999 a abril de 2009, dentre 338 cepas recuperadas, 72 obtidas de pacientes com meningite foram avaliadas. Quarenta e seis (63,9%) eram de pacientes do sexo masculino e a idade variou de um mês a 82,2 anos, com média de 18,4 ± 22,9 anos, mediana de 5,2 anos. As fontes de recuperação foram liquor [66 amostras (91,7%)] e sangue [seis (8,3%)]. Foram identificados 24 diferentes sorotipos de pneumococo e os mais comuns foram o 14, 19F, 3, 7F, 6A, 6B, 10A, 18C, 23F, 5 e 34, conferindo cifra de cobertura pela vacina conjugada 7-valente de 79,8% e pela 10- valente de 91,3% entre as crianças com idade até cinco anos. De 20 (27,8%) cepas oxacilinaresistentes, 17 (23,6%) confirmaram a resistência à penicilina e nove (12,5%) à ceftriaxona, tendo ambas predominado em crianças até 24 meses e no período de 2005 a 2009

Prevalence of pneumococcal serotypes and resistance to antimicrobial agents in patients with meningitis: ten-year analysis

OBJECTIVES: To determine the prevalence of pneumococcal serotypes and antimicrobial susceptibility in patients with meningitis, and to evaluate the implications for vaccine coverage. METHODS: Pneumococcal strains obtained from normally sterile fluids from patients admitted with meningitis were isolated at the Hospital de Clínicas of the Universidade Federal de Uberlândia, Minas Gerais State, and sent to the Instituto Adolfo Lutz, city of São Paulo, São Paulo State, for further identification, serotyping, and antimicrobial susceptibility determination. RESULTS: From April 1999 to April 2009, 338 pneumococcal strains were isolated, and 72 obtained from patients with meningitis, were analyzed. Patients' ages varied from one month to 82.2 years (mean of 18.4 ± 22.9 years; median of 5.2 years) and 46 (63.9%) patients were male. Strains were isolated from cerebrospinal fluid [66 occasions (91.7%)] and blood [6 occasions (8.3%)]. The most commonly identified serotypes were 14, 19F, 3, 7F, 6A, 6B, 10A, 18C, 23F, 5, and 34. Of the 20 [27.8%] oxacillin-resistant strains, 17 [23.6%] were resistant to penicillin and nine [12.5%] to ceftriaxone, both resistance patterns being more common in children aged two years or less and during the 2005-2009 period. CONCLUSIONS: Resistance to penicillin and ceftriaxone was detected in 23.6% and 12.5% of the strains, respectively, and predominated in children aged two years or less and during the 2005-2009 period. There were 24 different serotypes of pneumococcus and 79.8% of the serotypes were represented in the 7-valent conjugated vaccine [PVC7]

Novos pontos de corte de sensibilidade nas taxas de resistência antimicrobiana de cepas invasivas de pneumococo New susceptibility breakpoints in antimicrobial resistance rates of invasive pneumococcal strains

OBJETIVO: Avaliar impacto dos novos pontos de corte de sensibilidade à penicilina nas taxas de resistência de cepas de pneumococo obtidas de crianças com pneumonia. MÉTODOS: Cepas de pneumococo isoladas no laboratório de análises clínicas do Hospital de Clínicas de Uberlândia, Uberlândia (MG), a partir de amostras de pacientes internados foram enviadas ao Instituto Adolfo Lutz, Sao Paulo (SP), para confirmação da identificação, sorotipagem e determinação da sensibilidade aos antimicrobianos. RESULTADOS: De abril de 1999 a dezembro de 2008 foram enviadas ao Instituto Adolfo Lutz 330 cepas de pneumococo, sendo 195 (59%) provenientes de pacientes com diagnóstico de pneumonia. Destas, foram analisadas 100 cepas de pacientes com idade &#8804; 12 anos; a idade dos pacientes variou de 1 a 12,6 anos, com média de 2,4 e mediana de 1,7 anos; 47 pacientes eram do sexo masculino; as fontes de recuperação foram sangue (42%) e líquido pleural (58%). Foram detectadas 35 cepas oxacilina-resistentes: segundo os critérios do Clinical and Laboratory Standards Institute (CLSI) de 2007 [concentração inibitória mínima (CIM) &#8804; 0,06 µg/mL para sensibilidade (S), 0,12 a 1 µg/mL para resistência intermediária (RI) e &#8805; 2 µg/mL para resistência plena (RP)], 22 cepas apresentaram RI e 11, RP para penicilina. De acordo com os critérios atuais do CLSI de 2008 (&#8804; 2 µg/mL para S, 4 µg/mL para RI e &#8805; 8 µg/mL para RP) apenas uma cepa confirmou RI à penicilina. Detectou-se resistência a cotrimoxazol (80%), tetraciclina (21%), eritromicina (13%), clindamicina (13%) e ceftriaxona (uma cepa, simultaneamente resistente a penicilina). CONCLUSÕES: Com a aplicação dos novos pontos de corte para sensibilidade in vitro, as taxas de resistência a penicilina caíram 97%, de 33 para 1%.<br>OBJECTIVE: To evaluate the impact of new penicillin susceptibility breakpoints on resistance rates of pneumococcal strains collected from children with pneumonia. METHODS: Pneumococcal strains collected from patients admitted with pneumonia were isolated at the clinical analysis lab of Hospital de Clínicas de Uberlândia, Uberlândia, Brazil, and sent to Instituto Adolfo Lutz, São Paulo, Brazil, for further identification, serotyping and determination of antimicrobial susceptibility. RESULTS: From April 1999 to December 2008, 330 strains of pneumococcus were sent to Instituto Adolfo Lutz; of these, 195 (59%) were collected from patients with pneumonia. One hundred strains collected from patients &#8804; 12 years old were analyzed. The patients' age ranged from 1 to 12.6 years old (with mean age of 2.4 and median of 1.7 years). Forty-seven patients were male. The strains were isolated from blood (42%) and pleural fluid (58%). There were 35 oxacillin-resistant strains: according to the criteria defined by the Clinical and Laboratory Standards Institute (CLSI) in 2007 [minimum inhibitory concentration (MIC) &#8804; 0.06 µg/mL for susceptibility (S), 0.12 to 1 µg/mL for intermediate resistance (IR), and &#8805; 2 µg/mL for full resistance (FR)], 22 strains had IR and 11 strains had FR. According to the current breakpoints defined by the CLSI in 2008 (&#8804; 2 µg/mL for S, 4 µg/mL for IR and &#8805; 8 µg/mL for FR), only one strain had IR to penicillin. There was resistance to co-trimoxazole (80%), tetracycline (21%), erythromycin (13%), clindamycin (13%), and ceftriaxone (one strain simultaneously resistant to penicillin). CONCLUSIONS: When the new breakpoints for in vitro susceptibility were applied, penicillin resistance rates dropped 97%, from 33 to 1%