Influencia de la edad en la enfermedad neumocócica invasiva y en la resistencia a antimicrobianos / Influence of age on the clinical manifestations of invasive pneumococcal disease and antibiotic resistance rates

Fundamento y objetivo: La enfermedad invasiva por Streptococcus pneumoniae (EISP) presenta variaciones epidemiológicas en relación con la edad y el serotipo de neumococo aislado. Los objetivos del trabajo fueron analizar las formas clínicas y la mortalidad de EISP, los serotipos aislados y la tasa de resistencia a antimicrobianos en diferentes grupos de edad. Pacientes y método: Se estudiaron 141 pacientes con EISP diagnosticados entre 2002 y 2008 y se clasificaron en 4 grupos: ≤ 2 años, 3-14 años, 15-64 años y ≥ 65 años. Resultados: La neumonía que la manifestación más frecuente (71%) en todos los grupos de edad. En el grupo ≤ 2 años destacó una mayor prevalencia de meningitis (28 frente a 9%, p = 0,054) y en el grupo 3-14 años el empiema fue más frecuente (31 frente a 5%, p < 0,001). La mortalidad se asoció con la edad ≥ 65 años (odds ratio [OR] 7, intervalo de confianza del 95% [IC 95%] 1,9-28,9), la bacteriemia primaria (OR 7, IC 95% 1,9-28,9) y la intubación orotraqueal (OR 9, IC 95% 1,9-41,1). Los serotipos más prevalentes en ≤ 2 años fueron 14, 19A y 19F, el serotipo 1 en el grupo 3-14 años y el 3 en ≥ 65 años. En la población pediátrica se observó una mayor tasa de cepas no sensibles a penicilina (42 frente a 18%, p = 0,007). Conclusiones: La edad se relacionó con las formas clínicas, la mortalidad y la resistencia a antimicrobianos. La bacteriemia primaria constituyó uno de los factores asociados con una mayor mortalidad (AU)

Background and objective: Invasive pneumococcal disease (IPD) shows different epidemiological characteristics depending on age and pneumococcus serotype. The aims of the work were to analyze the clinical manifestations and mortality associated with IPD, the serotype isolated and the antibiotic resistance rates in different age groups. Patients and method: Retrospectively, 141 patients with IPD diagnosed between 2002 and 2008 were studied. Patients were classified in 4 age groups: 2 year-old, 3-14 year-old, 15-64 year-old and 65 year-old. Results: Pneumonia was the most common manifestation in all age groups (71%). Pneumococcal meningitis was more prevalent in patients 2 year-old (28 vs. 9%, P = .054) and empyema was more frequent in those between 3-14 year-old (31 vs. 5%, P < .001). Mortality was associated with age 65 year-old (odds ratio [OR] 7, 95% confidence interval [95% CI] 1.9-28.9), primary bacteremia (OR 7, 95% CI 1.9-28.9) and orotracheal intubation (OR 9, 95% CI 1.9-41.1). The more prevalent serotypes among patients 2 year-old were 14, 19A and 19F. The serotype 1 was most common in patients between 3-14 year-old and serotype 3 in those 65 year-old. A higher rate of non-susceptible penicillin strains was observed in pediatric population (42 vs. 19%, P = .007). Conclusions: Age was related to the clinical manifestations, mortality and antibiotic resistance rates. Primary bacteremia was one of the risk factors of mortality (AU)

[Influence of age on the clinical manifestations of invasive pneumococcal disease and antibiotic resistance rates]. / Influencia de la edad en la enfermedad neumocócica invasiva y en la resistencia a antimicrobianos.

BACKGROUND AND OBJECTIVE: Invasive pneumococcal disease (IPD) shows different epidemiological characteristics depending on age and pneumococcus serotype. The aims of the work were to analyze the clinical manifestations and mortality associated with IPD, the serotype isolated and the antibiotic resistance rates in different age groups. PATIENTS AND METHOD: Retrospectively, 141 patients with IPD diagnosed between 2002 and 2008 were studied. Patients were classified in 4 age groups: ≤ 2 year-old, 3-14 year-old, 15-64 year-old and ≥ 65 year-old. RESULTS: Pneumonia was the most common manifestation in all age groups (71%). Pneumococcal meningitis was more prevalent in patients ≤ 2 year-old (28 vs. 9%, P=.054) and empyema was more frequent in those between 3-14 year-old (31 vs. 5%, P<.001). Mortality was associated with age ≥ 65 year-old (odds ratio [OR] 7, 95% confidence interval [95% CI] 1.9-28.9), primary bacteremia (OR 7, 95% CI 1.9-28.9) and orotracheal intubation (OR 9, 95% CI 1.9-41.1). The more prevalent serotypes among patients ≤ 2 year-old were 14, 19A and 19F. The serotype 1 was most common in patients between 3-14 year-old and serotype 3 in those ≥ 65 year-old. A higher rate of non-susceptible penicillin strains was observed in pediatric population (42 vs. 19%, P=.007). CONCLUSIONS: Age was related to the clinical manifestations, mortality and antibiotic resistance rates. Primary bacteremia was one of the risk factors of mortality.