Serotypes and Clonal Composition of Streptococcus pneumoniae Isolates Causing IPD in Children and Adults in Catalonia before 2013 to 2015 and after 2017 to 2019 Systematic Introduction of PCV13.

The goal of this study was to investigate the distribution of serotypes and clonal composition of Streptococcus pneumoniae isolates causing invasive pneumococcal disease (IPD) in Catalonia, before and after systematic introduction of PCV13. Pneumococcal strains isolated from normally sterile sites obtained from patients of all ages with IPD received between 2013 and 2019 from 25 health centers of Catalonia were included. Two study periods were defined: presystematic vaccination period (2013 and 2015) and systematic vaccination period (SVP) (2017 to 2019). A total of 2,303 isolates were analyzed. In the SVP, there was a significant decrease in the incidence of IPD cases in children 5 to 17 years old (relative risk [RR] 0.61; 95% confidence interval [CI] 0.38 to 0.99), while there was a significant increase in the incidence of IPD cases in 18- to 64-year-old adults (RR 1.33; 95% CI 1.16 to 1.52) and adults over 65 years old (RR 1.23; 95% CI 1.09 to 1.38). Serotype 8 was the major emerging serotype in all age groups except in 5- to 17-year-old children. In children younger than 5 years old, the main serotypes in SVP were 24F, 15A, and 3, while in adults older than 65 years they were serotypes 3, 8, and 12F. A significant decrease in the proportions of clonal complexes CC156, CC191, and ST306 and an increase in those of CC180, CC53, and CC404 were observed. A steady decrease in the incidence of IPD caused by PCV13 serotypes indicates the importance and impact of systematic vaccination. The increase of non-PCV13 serotypes highlights the need to expand serotype coverage in future vaccines and rethink vaccination programs for older adults. IMPORTANCE We found that with the incorporation of the PCV13 vaccine, the numbers of IPD cases caused by serotypes included in this vaccine decreased in all of the age groups. Still, there was an unforeseen increase of the serotypes not included in this vaccine causing IPD, especially in the >65-year-old group. Moreover, a significant increase of serotype 3 included in the vaccine has been observed; this event has been reported by other researchers. These facts call for the incorporation of more serotypes in future vaccines and a more thorough surveillance of the dynamics of this microorganism.

[Isolation of Haemophilus spp. from samples of pleural fluid: 11 years' review]. / Aislamiento de Haemophilus spp. en muestras de líquido pleural: revisión de 11 años.

BACKGROUND: The incidence and significance of Haemophilus spp. in plural fluid were retrospectively studied over a period of 11 years. METHODS: Gram staining and culture in aerobic and anaerobic media was performed in 7517 pleural fluids. Haemophilus spp. was identified with the AMS-Vitek and/or conventional systems. The presence of beta-lactamase was assessed by this method or by the acidometric method. RESULTS: Haemophilus spp. was identified in 72 samples (0.9%) corresponding to 37 patients. The medical records of 22 were reviewed. The most common species isolated was H. influenzae. Gram stain exam was positive on 28 occasions (38.8%), with gram-negative bacilli being observed in 78.5%. A pure culture was obtained in 43 samples with anaerobic bacteria associated in 18% of the cases. Only 10 strains (16.4%) produced beta-lactamase. No predominance of any determined biotype was observed. Most of the patients were male with a mean age of 59.2 years (range: 2-82). Seventeen patients presented with community-acquired pneumonia, as well as tuberculous sequelae, pneumonectomy and pulmonary and/or upper GI truct neoplasms. All were treated with antibiotics, beta-lactam drugs alone or with aminoglycosides. Half of them also required surgical drainage. Four patients died in relation with the underlying disease. CONCLUSIONS: Haemophilus spp. was isolated in 7.7% of 7517 samples of pleural fluid. This finding may indicate the coexistence of an underlying thoracic disease of neoplastic origin.

[Bite wound infections: study of 22 hospitalized patients]. / Infecciones en heridas por mordedura: estudio de 22 pacientes hospitalizados.

BACKGROUND: To study the characteristics of bite wounds with unfavorable evolution, developing infectious complications that requires hospital admission. METHODS: The data from 22 patients admitted to the Ciudad Sanitaria Vall d'Hebron hospital for the above mentioned reason over the last 5 years were reviewed. RESULTS: The patients (8 males, 8 females and 6 children) were bitten by 10 dogs, 6 cats, and 6 men with predominance of the wound site being in the upper limb (10) followed by the lower limbs (6), head or face (5) and exceptionally on the breast (1). The most frequent clinical manifestation was abscess and/or cellulitis (13) and adenopathies or lymphangitis (4); 5 patients presented osteoarticular involvement including 3 bone fractures due to human aggression. With regard to the etiology of infection, the common bucal flora bacteria were isolated in all the cases; Pasteurella multocida in 15/16 animal bites, Eikenella corrodens associated to streptococcus in 5/6 human bites, Fusobacterium spp. (5), Bacteroides spp. (3) and Peptococcus sp. (1). The most frequently administered antibiotics were gentamycin (15), penicillin (13), cloxacillin (5) and clindamycin (4). The evolution was favorable, although slow in many cases, with sequelae in 3 patients. CONCLUSIONS: It is very difficult to foresee in which cases infectious complications will develop in bite wounds. According to the authors' experience, in the case of deep wounds the bacteria implied come from the mouth of the aggressor. Careful cleansing, rapid administration of an adequate antibiotic and clinical control being the most recommendable procedure.