Prevalência de sorotipos e resistência antimicrobiana de cepas invasivas do Streptococcus pneumoniae

Abstract

Objective: To determine the prevalence of serotypes and antimicrobial susceptibility of invasive strains of Streptococcus pneumoniae and to discuss the implications of these findings for vaccine formulation. Method:Strains of Streptococcus pneumoniae obtained from normally sterile fluids from patients admitted with invasive diseases were isolated and identified at the Hospital de Clínicas, Universidade Federal de Uberlândia, state of Minas Gerais, and forwarded to Instituto Adolfo Lutz, state of São Paulo, for further identification, serotyping and determination of antimicrobial susceptibility. . Eighty-four (56.7%) patients were male. The most common diagnoses were pneumonia (91 cases; 61.4%), meningitis (32 cases; 21.6%) and occult bacteremia (15 cases; 10.1%). Strains were isolated mostly from blood (76 occasions; 51.3%), pleural fluid (39 occasions; 26.3%) and cerebrospinal fluid (30 occasions; 20.2%). There were 23 different serotypes, and the most common were 14, 3, 1, 5, 6A, 6B and 18C. Among 30 (20.2%) oxacillin-resistant strains, 23 (15.5%) were confirmed as resistant to penicillin (12.8% intermediate resistance and 2.7% full resistance). Oxacillin-resistant strains were restricted to serotypes 14, 23F, 19A and 6B. Resistance to penicillin varied with age, being more common in children under two years of age (p = 0.0008). We observed decreased sensibility to sulfamethoxazole-trimethoprim (92 isolates; 63.4%), to erythromycin (12 isolates; 8.3%), to clindamycin (12 isolates; 8.7%), to ofloxacin (one strain; 0.8%) and to cefotaxime (three strains; 2%; also resistant to penicillin). All isolates were susceptible to chloramphenicol, rifampin and vancomycin. Conclusion:The decreased susceptibility to penicillin, detected in 15.5% of the strains was predominant in children under two years of age. There were 23 different Streptococcus pneumoniae serotypes. The 23-valent polysaccharide vaccine covers 82.6% of the serotypes and 90.2% of the invasive strains isolated in this population. In addition, 46.7% of the serotypes and 63.6% of the strains isolated from children until five years of age are covered in the currently available 7-valent conjugated vaccine (PN CRM7).J Pediatr (Rio J). 2003;79(6):537-42: Streptococcus pneumoniae, serotypes, vaccines.

Doença pneumocócica invasiva em crianças e adolescentes soropositivos para HIV

“…8,4,[10][11][12] Of this study, seven (54%) of the 13 children less than 2 years old had suffered IPD due to SpNSPn. It is possible that this high level of penicillin resistance is partially due to the fact that HIV+ patients are often given antimicrobial treatment.…”

“…The majority of these refer to colonization of the airways by Sp, since the difficulties in isolating the bacteria from cultures from people with pneumonia are well known. 4,[9][10][11][12][13] The only study published in Brazil on Sp serotypes identified from HIV+ children demonstrated that nasopharyngeal colonization of 112 children was no greater than that described in the literature for healthy children. 3 In our study, serotype 14 was the most frequent (four cases) and was also the serotype that exhibited greatest resistance to penicillin, which confirms data published in Brazilian literature.…”

Impacto da vacina conjugada contra Streptococcus pneumoniae em doenças invasivas

“…8,9 As the STs most frequently isolated from children with invasive and non-invasive diseases are the ones that present the greatest clonal variation, it is essential to develop new vaccines for preventing pneumococcal diseases. 8,9 At present, ST 19 A is the one that causes the greatest concern, not only because of being frequently isolated from vaccinated children that present with IPD in the USA, but also due to the increase in the rate of resistance to antimicrobial agents. 8,9,43,44 …”

“…8,9 At present, ST 19 A is the one that causes the greatest concern, not only because of being frequently isolated from vaccinated children that present with IPD in the USA, but also due to the increase in the rate of resistance to antimicrobial agents. 8,9,43,44 …”

“…[4][5][6][7] Pneumococcal diseases are more common in children younger than 2 years, elderly people, and in certain groups of individuals that present conditions associated with the development of invasive pneumococcal diseases (IPD) ( Table 2). [1][2][3][4][5][6][7][8][9][10][11][12] Moreover, they affect poorer populations more seriously, aggravating the situation of these populations even further. 1,4 In Brazil, the highest rate of incidence of pneumococcal meningitis has been registered in nursing infants younger than 1 year, and bacterial resistance has increased progressively.…”