MIDDLE-EAR FLUID STREPTOCOCCUS PNEUMONIAE SUSCEPTIBILITY AND SEROTYPE AND DISTRIBUTION IN MEXICAN CHILDREN WITH ACUTE OTITIS MEDIA

Abstract

INTRODUCTION:The mortality rate for dengue shock syndrome (DSS) in the PICU at Children's and Maternity Harapan Kita Hospital is still high (13.2%). OBJECTIVE: We evaluated performance of the Pediatric Logistic Organ Dysfunction (PELOD) score compared with the Pediatric Risk of Mortality III (PRISM III) for predicting mortality in our PICU. METHODS: A total of 42 patients (48% boys, 52% girls) admitted to the PICU from January to December 2006 were enrolled onto the study. Diagnosis of DSS was made according to 1997 World Health Organization criteria and confirmed with serologic-positive dengue blot taken on the fifth day of fever (93% secondary infection and 7% primary infection). PELOD and PRISM scores were evaluated on the first day. RESULTS: From 42 admissions, 1 was excluded for insufficient data. Median age of the children was 7 years. Death occurred in 11.9% of the patients with DSS. Analysis showed that the mean PELOD score was 7.2 (MannWhitney U test between survivors and nonsurvivors was significant at P ϭ .001) compared with the PRISM III (mean score was significant also at P ϭ .008). The receiver operating characteristic curves for the PELOD and PRISM III were 0.954 and 0.868, respectively. CONCLUSIONS: PELOD and PRISM III scores showed a good discrimination for predicting mortality in patients with DSS in our PICU. MIDDLE-EAR FLUID RESULTS:The most common S pneumoniae serotypes isolated were 6B and 19F (16.67% each) and 6A, 14, and 23F (15.27% each). The overall rate of resistance (defined as the rate of intermediate resistance plus the rate of resistance) for penicillin was 65.38% (intermediate and resistant categories were 29.17% and 36.11%, respectively), for cefotaxime was 19.45%, for azithromycin and erythromycin was 23.61%, for trimethoprim/ sulfamethoxazole was 61.11%, for amoxicillin was 5.5%, and for clindamycin was 12.5%. With amoxicillin/clavulanate, ceftriaxone, imipenem, meropenem, teicoplanin, telithromycin, and vancomycin, we found susceptibility for 100% of the isolates. The most common resistant serotypes were 19F and 23F. CONCLUSIONS: The serotype distribution of S pneumoniae that causes pediatric AOM in Mexico is similar to that reported from developed countries. The current heptavalent pneumococcal conjugate vaccine covers 63.89% of AOM episodes in Mexican children.

Evaluación Económica de un Programa de Inmunización Infantil en México Basado en la Vacuna Neumocócica Conjugada 13-Valente

“…La cobertura serotípica de las vacunas en México en bacteremia, meningitis y neumonía fue estimada en base a resultados del Sistema Regional de Vacunas [13]. Se usó la cobertura serotípica en OM reportada por Rodgers et al [25] y López et al [26].…”

“…Tasa de secuelas por meningitis % Deterioro neurológico [23] 18,0 Hipoacusia [24] 136,0 Cobertura serotípica de la PCV-7 % Bacteremia neumocócica [13] 58,3 Meningitis neumocócica [13] 61,9 Neumonía manejo hospitalario [13] 58,5 Neumonía manejo ambulatorio [13] 59,0 Otitis meda [25,26] 61,5 Efectos directos de la PCV-7 en ENI [27] 94,0…”

The prevalence of circulating S. pneumoniae serotypes in people older than 18 years: healthy carriers, patients with acute otitis media, community-acquired pneumonia, and invasive pneumococcal infections (epidemiological study «SPECTRUM»)

“…В нашем исследовании среди 19A, 19F [24]. Серотипами, ответственными за развитие ОСО после внедрения пневмококковой вакцины в рутинную практику в Мексике, являются 6B, 19F, 6A, 14, 23F, а в Чили -19F и 14 [25,26]. В Японии у пациентов с ОСО наиболее часто встречаются серотипы 15A, 3 и 35B [27], в США -серотипы 19, 23, 6, 14, 3 и 18 [28].…”

“…Перекрываемость серотипов S. pneumoniae, выделенных у пациентов с ИПИ, для ПКВ-13 составила 46,7%, а для ППВ-23 -73,3%, что соответствует тенденции к снижению процента перекрываемости циркулирующих серотипов пневмококковыми вакцинами с течением времени после внедрения пневмококковых вакцин в национальные графики иммунизации [20][21][22][23][24][25][26][27][28][29][30][31][32][33].…”

“…Эпидемиология серотипов S. pneumoniae несколько отличается от той, что мы наблюдали в ранее проведенном нами исследовании в детской популяции [25]. Большинство серотипов перекрываются ППВ-23, часть из которых не входит в состав ПКВ-13 (преимущественно за счет серотипа 11A/D).…”