Progresión temporal de la distribución de los serotipos de Streptococcus pneumoniae productores de enfermedad neumocócica invasiva en Galicia (España) y su relación con la resistencia a antibióticos (periodo 2011-2021) / Temporal progression of the distribution of Streptococcus pneumoniae serotypes causing invasive pneumococcal disease in Galicia (Spain) and its relationship with resistance to antibiotics (period 2011-2021)

Introducción: Streptococcus pneumoniae causa enfermedades graves en la población susceptible. La vacuna neumocócica conjugada (PCV) 13-valente (PCV13) se incluyó en el calendario infantil en 2011. Este estudio analiza la evolución de los serotipos de neumococo y de sus resistencias tras la PCV13. Métodos: Se incluyeron los neumococos serotipados en Galicia en 2011-2021. Se estudió la sensibilidad antibiótica siguiendo criterios EUCAST. Se analizaron los datos en 3 subperíodos: inicial (2011-2013), medio (2014-2017) y final (2018-2021). Se calcularon las prevalencias de los serotipos y el porcentaje de resistencia a los antibióticos más representativos. Resultados: Se incluyeron 2.869 aislados. Inicialmente el 42,7% presentaba tipos capsulares incluidos en la PCV13, frente al 15,4% al final. Los incluidos en la PCV20 y no en la PCV13 y PCV15 fueron el 12,5% inicialmente y el 41,3% al final. El 26,4% de los serotipos a lo largo del estudio no estaban incluidos en ninguna vacuna. La prevalencia del serotipo 8 se multiplicó casi por 8 y la del 12F se triplicó. El serotipo 19A fue el más resistente inicialmente. La resistencia de los serotipos 11A y 15A aumentó a lo largo del estudio. Conclusiones: La introducción de la PCV13 en la población infantil determinó un cambio en los serotipos de neumococo hacia los incluidos en la PCV20 y los no incluidos en ninguna vacuna. El serotipo 19A inicialmente fue el más resistente, y el 15A, no incluido en ninguna vacuna, merece un especial seguimiento. El serotipo 8, que fue el que más se incrementó, no mostró resistencia destacable.(AU)

Introduction: Streptococcus pneumoniae causes serious diseases in the susceptible population. The 13-valent pneumococci conjugate vaccine (PCV13) was included in the children's calendar in 2011. The objective of the study was to analyze the evolution of pneumococcal serotypes and their resistance after PCV13. Methods: This study included the pneumococci serotyped in Galicia in 2011-2021. Antibiotic susceptibility was analyzed following EUCAST criteria. The data was analyzed in 3 sub-periods: initial (2011-2013), middle (2014-2017) and final (2018-2021). The prevalence of serotypes and their percentage of resistance to the most representative antibiotics were calculated. Results: A total of 2.869 isolates were included. Initially, 42.7% isolates presented capsular types included in PCV13, compared to 15.4% at the end. Those included in PCV20 and not in PCV13 and PCV15 were 12.5% at baseline and 41.3% at the end; 26.4% of the isolates throughout the study had serotypes not included in any vaccine. The prevalence of serotype 8 multiplied almost by 8 and that of 12F tripled. The 19A serotype was initially the most resistant, while the resistance of serotypes 11A and 15A increased throughout the study. Conclusions: The introduction of PCV13 in the pediatric population determined a change in pneumococcal serotypes towards those included in PCV20 and those not included in any vaccine. Serotype 19A was initially the most resistant and the 15A, not included in any vaccine, deserves special follow-up. Serotype 8, which increased the most, did not show remarkable resistance.(AU)

Temporal progression of the distribution of Streptococcus pneumoniae serotypes causing invasive pneumococcal disease in Galicia (Spain) and its relationship with resistance to antibiotics (period 2011-2021).

INTRODUCTION: Streptococcus pneumoniae causes serious diseases in the susceptible population. The 13-valent pneumococci conjugate vaccine (PCV13) was included in the children's calendar in 2011. The objective of the study was to analyze the evolution of pneumococcal serotypes and their resistance after PCV13. METHODS: This study included the pneumococci serotyped in Galicia in 2011-2021. Antibiotic susceptibility was analyzed following EUCAST criteria. The data was analyzed in 3 sub-periods: initial (2011-2013), middle (2014-2017) and final (2018-2021). The prevalence of serotypes and their percentage of resistance to the most representative antibiotics were calculated. RESULTS: A total of 2.869 isolates were included. Initially, 42.7% isolates presented capsular types included in PCV13, compared to 15.4% at the end. Those included in PCV20 and not in PCV13 and PCV15 were 12.5% at baseline and 41.3% at the end; 26.4% of the isolates throughout the study had serotypes not included in any vaccine. The prevalence of serotype 8 multiplied almost by 8 and that of 12F tripled. The 19A serotype was initially the most resistant, while the resistance of serotypes 11A and 15A increased throughout the study. CONCLUSIONS: The introduction of PCV13 in the pediatric population determined a change in pneumococcal serotypes towards those included in PCV20 and those not included in any vaccine. Serotype 19A was initially the most resistant and the 15A, not included in any vaccine, deserves special follow-up. Serotype 8, which increased the most, did not show remarkable resistance.

Streptococcus pneumoniae: distribución de serotipos, sensibilidad antibiótica, factores de riesgo y mortalidad en Galicia en un periodo de 2 años / Streptococcus pneumoniae: Serotype distribution, antimicrobial susceptibility, risk factors and mortality in Galicia over a two year-period

INTRODUCCIÓN: Para conocer la epidemiología de la infección neumocócica en Galicia (España) tras la incorporación de la vacuna conjugada antineumocócica, se determinaron durante los años 2011 y 2012 la distribución de serotipos, sensibilidad antibiótica, factores de riesgo y mortalidad asociada de los casos de enfermedad neumocócica invasiva (ENI). MÉTODOS: Se estudiaron todas las cepas causantes de ENI en Galicia. El serotipado se realizó por aglutinación y reacción de Quellung. Se determinó la sensibilidad a penicilina, cefotaxima, eritromicina, vancomicina y levofloxacino. Se consideraron factores de riesgo la patología respiratoria crónica, la patología cardíaca, la patología hepática, la patología renal, la diabetes mellitus y la inmunodeficiencia no VIH y VIH. RESULTADOS: Se recogieron 555 cepas. Se encontraron 43 serotipos diferentes, los más frecuentes: serotipo 3 (17,5%), serotipo 7F (12,6%), serotipo 19A (9,4%), serotipo 14 (4,1%), serotipo 6C (4,1%), serotipo 11A (4%) y serotipo 22F (3,8%). El 57,1% de los serotipos aislados estaban incluidos en VNC-13V. Se encontraron 2 cepas no sensibles a penicilina y otras 2 a cefotaxima. El 24,7% de las cepas fueron no sensibles a eritromicina (26,9% en 2011 y 22,5% en 2012). La tasa de letalidad fue del 16,5%, llegando al 23,3% en mayores de 75 años. Las patologías con riesgo de morir que mostraron significación estadística fueron: hepática, renal e inmunodeficiencia no VIH. CONCLUSIONES: El serotipo 3 fue el mayoritario en Galicia. Se encontraron muy pocas cepas no susceptibles a penicilina y un descenso de resistencia a eritromicina de 2011 a 2012. Se observó un incremento de letalidad en relación con la edad del paciente. Padecer patología hepática, renal o inmunodeficiencia no VIH aumentó el riesgo de muerte

INTRODUCTION: To examine the epidemiology of pneumococcal infection in Galicia (Spain) after the incorporation of the pneumococcal conjugate vaccine, and to determine serotype distribution, antibiotic susceptibility, risk factors and associated mortality in cases of invasive pneumococcal disease (IPD) during 2011 and 2012. METHODS: All strains causing IPD in Galicia were studied. Serotyping was performed by agglutination and Quellung reaction. Antibiotic sensitivity to penicillin, cefotaxime, erythromycin, vancomycin, and levofloxacin was determined. The risk factors considered were chronic respiratory disease, heart disease, liver disease, kidney disease, diabetes mellitus, and HIV and non-HIV immunodeficiency. RESULTS: A total of 555 strains were collected, with 43 different serotypes being found. The most frequently isolated ones were: serotype 3 (17.5%), serotype 7F (12.6%), serotype 19A (9.4%), serotype 14 (4.1%), serotype 6C (4.1%), serotype 11A (4%) and serotype 22F (3.8%). 57.1% of isolates were serotypes included in VNC-13V. Two non-penicillin-sensitive strains and two others were not sensitive to cefotaxime, and 24.7% of the strains were not susceptible to erythromycin (26.9% in 2011 and 22.5% in 2012). The case fatality rate was 16.5%, reaching 23.3% in patients over 75 years. Diseases with a statistically significant risk of mortality were: liver, kidney and immunodeficiency without HIV. CONCLUSIONS: Serotype 3 was the most frequent in Galicia. Very few strains were not susceptible to penicillin. Erythromycin resistance decreased from 2011 to 2012. It is highlighted that mortality increases with age. Liver disease, renal disease and non-HIV immunodeficiency increases the mortality risk

[Streptococcus pneumoniae: serotype distribution, antimicrobial susceptibility, risk factors and mortality in Galicia over a two year-period]. / Streptococcus pneumoniae: distribución de serotipos, sensibilidad antibiótica, factores de riesgo y mortalidad en Galicia en un periodo de 2 años.

INTRODUCTION: To examine the epidemiology of pneumococcal infection in Galicia (Spain) after the incorporation of the pneumococcal conjugate vaccine, and to determine serotype distribution, antibiotic susceptibility, risk factors and associated mortality in cases of invasive pneumococcal disease (IPD) during 2011 and 2012. METHODS: All strains causing IPD in Galicia were studied. Serotyping was performed by agglutination and Quellung reaction. Antibiotic sensitivity to penicillin, cefotaxime, erythromycin, vancomycin, and levofloxacin was determined. The risk factors considered were chronic respiratory disease, heart disease, liver disease, kidney disease, diabetes mellitus, and HIV and non-HIV immunodeficiency. RESULTS: A total of 555 strains were collected, with 43 different serotypes being found. The most frequently isolated ones were: serotype3 (17.5%), serotype7F (12.6%), serotype19A (9.4%), serotype14 (4.1%), serotype6C (4.1%), serotype11A (4%) and serotype22F (3.8%). 57.1% of isolates were serotypes included in VNC-13V. Two non-penicillin-sensitive strains and two others were not sensitive to cefotaxime, and 24.7% of the strains were not susceptible to erythromycin (26.9% in 2011 and 22.5% in 2012). The case fatality rate was 16.5%, reaching 23.3% in patients over 75years. Diseases with a statistically significant risk of mortality were: liver, kidney and immunodeficiency without HIV. CONCLUSIONS: Serotype3 was the most frequent in Galicia. Very few strains were not susceptible to penicillin. Erythromycin resistance decreased from 2011 to 2012. It is highlighted that mortality increases with age. Liver disease, renal disease and non-HIV immunodeficiency increases the mortality risk.

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.

Non-hospital-associated methicillin-resistant Staphylococcus aureus and MRSA chronic carrier patients in infection control.

This study reports research on methicillin-resistant Staphylococcus aureus (MRSA) colonized-infected patients who were admitted to a 320-bed hospital. Specifically, we report on the difficulties related to MRSA infection control as a consequence of the increasing incidence of non-hospital-associated MRSA acquisition and patients as chronic carriers who are frequently readmitted to the hospital.