12 years active surveillance for pediatric pleural empyema in a Mexican hospital: effectiveness of pneumococcal 13-valent conjugate vaccine, and early emergence of methicillin-resistant Staphylococcus aureus

Abstract

Background: Previous publications have proved the effectiveness of the 13-valent pneumococcal conjugate vaccine (PCV13) on pneumococcal pleural empyema (PnPE) in children, with little emergence of other pathogens. We searched the literature to establish whether PCV13 reduces PnPE, and to identify other pathogens causing pleural empyemas (PEs). Material and methods: From October 2005 to January 2018 (12.3 years) we performed active surveillance for all cases of PE at the General Hospital of Tijuana, Mexico. Isolates from pleural fluid (PF) were identified by conventional culture, and since 2014, polymerase chain reaction (PCR) was added for all culture-negative PFs. Streptococcus pneumoniae serotypes were detected by either Quellung reaction (Statens Serum Institute®) or PCR. Clinical, imagenological, laboratorial and microbiological evaluation was performed on each patient. Statistical analysis was purely descriptive. Results: A total of 64 PEs were identified (5.28/year). Median age was 51 months (1–191), hospitalization days 18 (4–35). Decortication was performed in 42%, and two children died (3.2%). Bacterial identification was obtained from 51 (80%). S. pneumoniae was the leading cause (29 = 56.8%), followed by Staphylococcus aureus (14 = 27.4%), Streptococcus pyogenes (3–5 = 9%) and others (5 = 9.8%). PCV13 was initiated in May 2012, and its impact on serotype-specific PnPE was 81% (much fewer than serotype 3) and for all PnPE 56.1%; however, for all PE −2.1% due to an increase of PE caused by S. aureus for all but one methicillin-resistant S. aureus (MRSA). Conclusions: Following 12.3 years of active surveillance, PCV13 has shown impact on both serotype-specific and all PnPEs; however, an increase of PEs by MRSA has emerged. Continuous surveillance is crucial to establish whether this epidemiological finding is transitory or not.

Surveillance of pediatric parapneumonic effusion/empyema in New Zealand

“…Pleural empyema is an uncommon but serious complication of childhood community-acquired pneumonia, 1 resulting in prolonged hospitalization, extended antibiotic therapy, and often requiring invasive intervention. 2 The most common causative organism reported internationally in pediatric empyema is Streptococcus pneumoniae, accounting for 41%-79% of cases [2][3][4][5] with Streptococcus pyogenes and Staphylococcus aureus less frequently recorded. [2][3][4][5] However, New Zealand (NZ) children have a high burden of S. aureus-related disease overall, 6,7 with previous studies identifying S. aureus as a significant cause of complicated pneumonia/parapneumonic effusion/empyema (PPE/E).…”

“…2 The most common causative organism reported internationally in pediatric empyema is Streptococcus pneumoniae, accounting for 41%-79% of cases [2][3][4][5] with Streptococcus pyogenes and Staphylococcus aureus less frequently recorded. [2][3][4][5] However, New Zealand (NZ) children have a high burden of S. aureus-related disease overall, 6,7 with previous studies identifying S. aureus as a significant cause of complicated pneumonia/parapneumonic effusion/empyema (PPE/E). [8][9][10] An increase in childhood empyema incidence has recently been reported in developed nations including Australia, the United States (US), the United Kingdom (UK), and other European countries.…”

Continuous Effectiveness of Pneumococcal 13-Valent Conjugate Vaccine on Pediatric Pneumococcal Otomastoiditis: Results of 15 Years of Active/Prospective Surveillance in a Mexican Hospital on the Mexico-US Border

“…However, its effectiveness in decreasing otomastoiditis (OM), a local/suppurative complication of AOM, has barely been reviewed [15][16][17][18]. We have performed several studies related to IPD, particularly by looking at the effectiveness of PCV13 on overall IPD and meningitis and pleural empyema [19][20][21].…”

Control of Methicillin-Resistant Staphylococcus aureus Strains Associated With a Hospital Outbreak Involving Contamination From Anesthesia Equipment Using UV-C

“…Approximately 30% of bacteremia’s associated with MRSA are manifested as sepsis or septic shock, which are associated with a significantly high mortality rate in the pediatric intensive care unit ( Hassoun et al, 2017 ). The prevalence of MRSA strains in Mexico of 21.4% has been linked to respiratory infections and significant increases in the prevalence of immunocompromised patients and patients with underlying respiratory diseases ( Chacon-Cruz et al, 2019 ; Garza-González et al, 2019 ). High prevalence rates of infections associated with hospital-acquired MRSA (HA-MRSA) have been reported worldwide since the sixties ( Kallen et al, 2010 ; Stefani et al, 2012 ; Lindsay, 2013 ; De la Rosa-Zamboni et al, 2018 ; Turner et al, 2019 ).…”