The potential role of 13-valent pneumococcal conjugate vaccine in preventing respiratory complications in bacteraemic pneumococcal community-acquired pneumonia.

INTRODUCTION: Pneumococcal 13-valent vaccine (PCV-13) has a potential role in preventing bacteraemic pneumococcal pneumonia and its complications, but little is known about its ability to specifically prevent respiratory complications. Our aim were to analyse the pneumococcal serotypes associated with the development of respiratory complications and the potential role of PCV-13 in preventing respiratory complications in bacteraemic pneumococcal pneumonia. MATERIAL AND METHODS: We analysed demographic characteristics, comorbidities, antibiotic resistances and the outcomes of a cohort of 65 vaccine-naïve bacteraemic pneumococcal pneumonias, stratified by the pneumococcal serotypes included in PCV13 vs. those not included. Complications were clustered as follows: respiratory complications (hypoxemic respiratory failure; mechanical ventilation), systemic complications (septic shock; multiorgan failure), suppurative complications (empyema; pleural effusion; lung abscess). RESULTS: From a population of 65 CAP-SP, 47.7% of the isolates belonged to PCV-13 serotypes group. No differences in comorbidities or clinical manifestations were found between groups. With regard to biochemical parameters, we found more profound hypoxemia levels in PCV-13 serotypes group comparing to non-vaccine group [PaO2/FiO2 209 (63) vs. 268 (57); p=0.007]. Global complications were identified in 69.2% (45 patients), and the most frequent were respiratory complications, found in 47.7%. Respiratory complications were detected more frequently in PCV-13 groups compared to non-vaccine groups (61.3% vs. 35.3%; p=0.036). Overall 30-day mortality was 30.8%. Mortality was similar between both groups (25.8% vs. 35.3%; p=0.408). CONCLUSIONS: Pneumococcal 13-valent conjugate vaccine includes the serotypes which cause more respiratory complications in our series; these serotypes were not associated with higher mortality in our series. PCV-13 may have a potential role in preventing respiratory complications due to bacteraemic pneumonoccal pneumonia.

¿Influyen la estación y el clima en la etiología de la neumonía adquirida en la comunidad? / Do Seasonal Changes and Climate Influence the Etiology of Community Acquired Pneumonia?

Introducción: La neumonía adquirida en la comunidad (NAC) es una patología muy prevalente cuya etiología viene dada por las características de la región geográfica y del paciente. El estudio de cada una de ellas es fundamental para su correcto abordaje terapéutico. Nos propusimos estudiar los cambios del agente causal de la NAC en función de la estacionalidad y la influencia de los cambios climáticos de nuestra área geográfica. Pacientes y método: Estudio prospectivo longitudinal de pacientes consecutivos ingresados por NAC desde enero de 2006 a diciembre de 2009. Analizamos datos sociodemográficos, comorbilidad, gravedad, agente etiológico, complicaciones y mortalidad. Correlacionamos la temperatura media y la precipitación acumulada media estacional para Streptococcus pneumoniae y Legionella pneumophila en cada estación del año. Análisis estadístico: Chi cuadrado, t de Student para muestras independientes, análisis de la varianza y correlación de Spearman. Resultados: Incluimos a 243 pacientes, 64,6% hombres y 54,7% mayores de 65 años. La mayor incidencia de NAC fue en invierno. Streptococcus pneumoniae fue el agente causal más frecuente en todas las estaciones del año a excepción del verano, en el que fue Legionella pneumophila. Observamos una correlación significativa entre la menor temperatura media estacional y la etiología neumocócica y a la inversa cuando el agente causal fue Legionella pneumophila. Sin embargo, no encontramos diferencias etiológicas por estaciones en relación con la humedad ambiental. Conclusiones: En nuestra área, Streptococcus pneumoniae es el agente etiológico más frecuente en invierno con bajas temperaturas mientras que en verano, con altas temperaturas, es Legionella pneumophila(AU)

Introduction: Community acquired pneumonia (CAP) is a highly prevalent pathology whose etiology is determined by the characteristics of the geographic region, the causative agent and the patient. The study of these features is essential for a proper therapeutic approach. Our aim was to study the changes of the causative agent of CAP brought about by the influence of seasonal and climatic changes in our geographic area. Patients and methods: A prospective and longitudinal study of patients admitted with CAP was done from January 2006 to December 2009. We analyzed demographic data, comorbidities, severity, etiologic agent, complications and mortality. We correlated mean temperature and mean cumulative rainfall for each season with Streptococcus pneumoniae and Legionella pneumophila. Statistical analyses included: Chi squared test, Student's t-test for independent samples, variance analysis and Spearman's correlation. Results: We included 243 patients, 64.6% men and 54.7% over the age of 65. The highest incidence of CAP was in the winter. S. pneumoniae was the most common causative agent for all seasons except in summer when the main agent was L. pneumophila. We observed a significant correlation between the lowest seasonal average temperature and pneumococcal etiology of CAP; inversely, with higher temperatures, L. pneumophila was more common. No etiological differences were found by season when related with environmental humidity. Conclusions: In our area, S. pneumoniae was the most common etiological agent in winter with low temperatures; in summer, with high temperatures, the most frequent was L. pneumophila(AU)

Do seasonal changes and climate influence the etiology of community acquired pneumonia?

INTRODUCTION: Community acquired pneumonia (CAP) is a highly prevalent pathology whose etiology is determined by the characteristics of the geographic region, and the patient. The study of these features is essential for a proper therapeutic approach. Our aim was to study the changes of the causative agent of CAP brought about by the influence of seasonal and climatic changes in our geographic area. PATIENTS AND METHOD: A prospective and longitudinal study of patients admitted with CAP was done from January 2006 to December 2009. We analyzed demographic data, comorbidities, severity, etiologic agent, complications and mortality. We correlated mean temperature and mean cumulative rainfall for each season with Streptococcus pneumoniae and Legionella pneumophila. Statistical analyses included: Chi squared test, Student's t test for independent samples, variance analysis and Spearman's correlation. RESULTS: We included 243 patients, 64.6% men and 54.7% over the age of 65. The highest incidence of CAP was in the winter. Streptococcus pneumoniae was the most common causative agent for all seasons except in summer when the main agent was Legionella pneumophila. We observed a significant correlation between the lowest seasonal average temperature and pneumococcal etiology of CAP; inversely, with higher temperatures, Legionella pneumophila was more common. No etiological differences were found by season when related with environmental humidity. CONCLUSIONS: In our area, Streptococcus pneumoniae was the most common etiological agent in winter with low temperatures; in summer, with high temperatures, the most frequent was Legionella pneumophila.