Changes in the incidence of acute bacterial meningitis caused by Streptococcus pneumoniae and the implications of serotype replacement in children in Colombia after mass vaccination with PCV10.

Introduction: Acute bacterial meningitis (ABM) is a public health problem. The disease has reemerged after the introduction of pneumococcal conjugate vaccines (PCVs) due to an increase in serotypes that are not covered. The objective was to determine the changes in the disease incidence before and after the introduction of the 10-valent vaccine (PCV10) in Colombia. Methods: This multicenter study was conducted in 17 hospitals in Colombia. Data were collected from January 2008 to December 2019 in 10 hospitals in Bogotá and from January 2017 to December 2019 in seven hospitals in Cali, Medellín and Cartagena. The data were grouped into three periods: 2008-2011, 2012-2015, and 2016-2019. Results: Of the 706 cases of invasive pneumococcal disease, 81 (11.4%) corresponded to meningitis. The relative incidence in Bogotá in the first period was 0.6 per 100,000 patients ≤ 5 years, decreased to 0.4 per 100,000 patients ≤ 5 years in the second period and increased in the third period to 0.7 per 100,000 patients ≤ 5 years. Serotypes covered by PCV10 decreased from 75 to 9.1%, with Spn19A (31.8%) and Spn34 (13.6%) emerging in the third period. Increased resistance to penicillin (13 to 37%) and to ceftriaxone (5.9 to 16%) was due to the emergence of multidrug-resistant Spn19A. The total mortality rate was 23.5% and increased from 12 to 33%. Conclusions: ABM due to pneumococcus has high morbidity and mortality rates. Reemergence of the disease has been observed due to the inclusion of polymerase chain reaction (PCR) for diagnosis and replacement of circulating serotypes after the introduction of PCV10, with an increase in Spn19A, which causes death and exhibits antimicrobial resistance. Continued surveillance is needed.

Differences Between Methicillin-susceptible Versus Methicillin-resistant Staphylococcus aureus Infections in Pediatrics: Multicenter Cohort Study Conducted in Bogotá, Colombia, 2014-2018.

BACKGROUND: The epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) has changed in recent years. The present article is intended to establish differences between clinical, laboratory and imaging findings and outcomes of MSSA and MRSA infections, as well as among subgroups of infection such as skin and soft tissue infection, osteoarticular, bacteremia or pneumonia in a pediatric population from Bogota, Colombia. METHODS: Retrospective cohort study using clinical records of patients under 18 years of age treated at the participating centers in Bogota, Colombia, between 2014 and 2018. The first positive S. aureus culture was studied. MSSA and MRSA were compared. The χ2 test, Fisher exact test, and Kruskal-Wallis test were calculated, and the statistical significance was presented using the difference and its 95% CI. RESULTS: Five hundred fifty-one patients were included; 211 (38%) corresponded to MRSA and 340 (62%) to MSSA for a total of 703 cultures. A significantly higher probability of having an MSSA infection than MRSA was found in patients with previous heart disease (3.3% vs. 0.5%), neurologic disease (5.9% vs. 2.5%), recent major surgeries (11% vs. 5%) or who has an implanted device (11% vs. 4%). In contrast, in severe MRSA infections (bacteremia, osteoarticular infections and pneumonia), a higher rate of complications was seen (admission to the pediatric intensive care unit, mechanical ventilation and vasoactive support), and in osteoarticular MRSA, more than 1 surgery per case was seen (89% vs. 61%). Laboratory results and mortality were similar. CONCLUSIONS: MRSA was associated with a more severe course in bacteremia, osteoarticular infections and pneumonia. Some classical risk factors associated with MRSA infections were found to be related to MSSA. In general, with the exception of skin and soft tissue infection, there was an increased risk of pediatric intensive care unit admission and mechanical and inotropic support with MRSA in a pediatric population.

Tuberculosis en pacientes con infección por VIH en el Hospital Universitario de San Ignacio, 2002-2006 / Tuberculosis in patients with HIV infection at the Hospital Universitario de San Ignacio, 2002-2006

Introducción. La prevalencia de coinfección por VIH y tuberculosis es alta en los países en vías de desarrollo. El objetivo del estudio fue describir la incidencia, las características clínicas, el tratamiento y el resultado del mismo en pacientes con coinfección por tuberculosis y VIH/sida en el Hospital Universitario de SanIgnacio en Bogotá, Colombia, durante los años 2002 a 2006. Materiales y métodos. Se seleccionaron pacientes con coinfección VIH/sida y tuberculosis. La revisión de las historias clínicas se hizo mediante un instrumento diseñado para la recolección de variables demográficas, clínicas, radiográficas y de la respuesta al tratamiento antituberculoso y antirretroviral. Resultados. Se identificaron 24 pacientes en el programa, de los cuales, 79% eran hombres, con una edad promedio de 30 años. La incidencia anual osciló entre 0,62% y 3,5%. La principal forma de diagnóstico fue por anatomía patológica, en 63% de los casos. Se identificó tuberculosis pulmonar en 37%, extrapulmonar en 42% y diseminada en 21%. El recuento de CD4 en el momento del diagnóstico fue inferior a 200 en 79% de las ocasiones, con un promedio de 113 por mm³. A todos los pacientes se les suministró tratamiento antituberculoso con cuatro medicamentos y se registró una mortalidad de 20% en el grupo de pacientes con seguimiento completo. La mortalidad no se modificó sino a partir del segundo mes de tratamiento (p < 0,04). Discusión y conclusiones. La mortalidad en pacientes con coinfección por tuberculosis y VIH fue alta, con un diagnóstico complicado debido a la baja sensibilidad de la baciloscopia de esputo y del cultivo. Es posible que se requieran medidas de quimioprevención en pacientes con recuentos de CD4 menores de 200.

Background HIV and tuberculosis coinfection prevalence is high in developing countries. The objective of the present study was to describe the incidence, clinical characteristics, treatment and the clinical outcomes in patients with HIV/aids and tuberculosis coinfection at the Hospital Universitario de San Ignacio in Bogotá Colombia, between the years 2002 and 2006. Materials and methods.We selected patients with HIV/aids and tuberculosis coinfection and reviewed the medical charts. Data was collected using a sheet for demographic, clinical and radiographical information, and outcomes of the antituberculous and antiretroviral treatment. Results 24 patients were identified, 79% were male, with an average age of 30 years. Annual incidence had a range between 0.62% and 3.5%. The main diagnostic method was pathological results in 63% of the cases. The anatomical localization was pulmonary in 37%, extrapulmonary in 42% and milliary in 21%. The CD4 count was less than 200 in 79% of the cases, and the average CD4 count was 113 cells per mm3. All the patients had antituberculous treatment with four drugs and the mortality was 20% for the group of patients with a complete follow up. Mortality was not modified until the second month of treatment ( p < 0.04). Discussion and conclusions. Mortality in patients with tuberculosis was high and the diagnosis was difficult due to the low sensitivity of sputum smear and Mycobacterium culture. Patients with CD4 count less than 200 may require chemoprophylaxis.