The impact of vaccination on the burden of invasive pneumococcal disease from a nationwide surveillance program in Lebanon: an unexpected increase in mortality driven by non-vaccine serotypes.

BACKGROUND: The impact of pneumococcal conjugate vaccines (PCVs) on the burden of invasive pneumococcal disease (IPD) and serotype distribution was examined across age groups from data collected by the Lebanese Inter-Hospital Pneumococcal Surveillance Program. METHODS: Between 2005 and 2020, 593 invasive Streptococcus pneumoniae isolates were collected from 79 hospitals throughout Lebanon. Serotypes and antimicrobial resistance (AMR) profiles were identified, and trends compared over 3 eras: PCV7, post-PCV7/ pre-PCV13, and PCV13 eras. RESULTS: The prevalence of PCV7 serotypes decreased significantly from 43.6% in the PCV7 era to 17.8% during the PCV13 era (p<0.001). PCV13-only serotypes remained stable in the PCV13 compared to the post-PCV7 eras, especially serotypes 1 and 3, whereas non-vaccine types (NVT) increased throughout the study period, especially 24 and 16F. The mortality rate increased substantially from 12.5% (PCV7 era) to 24.8% (PCV13 era). A significant decrease in AMR was observed across the three study eras. CONCLUSION: PCVs substantially impacted IPD and AMR in vaccinated and unvaccinated populations despite an increase in mortality driven by NVT. Broadening the recommendation of vaccination to include older age-groups, using higher valency vaccines, and implementing stringent antimicrobial stewardship are likely to further impact the burden of IPD.

Positive Correlations Between Free Vitamin D and Bone Variables in a Group of Young Lebanese Women.

Optimizing bone mass in adulthood is of great importance to prevent the occurrence of osteoporosis in later age. Vitamin D is an essential component of bone health. Low-serum vitamin D is associated with low bone mineral density (BMD), which is an important predictor of fracture risk. However, most cells, apart from renal tubular cells, are exposed to free rather than to total 25-hydroxyvitamin D. Whether free vitamin D would be a better marker than total vitamin D is still under debate. The aim of the present study was to explore the relationships between serum total vitamin D, vitamin D-binding protein (BP), free vitamin D, and bone parameters in a group of young Lebanese women. This study included 88 young female adults aged between 18 and 35 yr. Body composition and BMD were assessed by dual-energy X-ray absorptiometry, and the lumbar spine trabecular bone score was derived. Bone mineral content (BMC) and BMD were measured at the whole body (WB), the lumbar spine (L1-L4), the total hip (TH), and the femoral neck (FN). To evaluate hip bone geometry, dual-energy X-ray absorptiometry scans were analyzed at the FN, the intertrochanteric region, and the femoral shaft by the Hip Structure Analysis program. The cross-sectional area, the index of axial compression strength, and the section modulus (Z), as well as index of bending strength, were measured from bone mass profiles. Composite indices of FN strength (compressive strength index [CSI], bending strength index, and impact strength index [ISI]) were calculated as previously described. Direct measurement of free 25-hydroxyvitamin D concentrations was performed by immunoassay, which detects free vitamin D by ELISA on a microtiter plate. Serum vitamin D BP was measured using a Quantikine ELISA kit, which employed the quantitative sandwich enzyme immunoassay technique. Serum free vitamin D was positively correlated with WB BMC (r = 0.26, p < 0.05), WB BMD (r = 0.29, p < 0.05), L1-L4 BMD (r = 0.28, p < 0.05), TH BMD (r = 0.34, p < 0.01), FN BMD (r = 0.29, p < 0.05), CSI (r = 0.24, p < 0.05), and ISI (r = 0.28, p < 0.05). No positive correlations were detected between the total vitamin D level, the vitamin D BPs, and BMD. The positive associations between free vitamin D and several bone variables (WB BMC, WB BMD, L1-L4 BMD, TH BMD, FN BMD, CSI, bending strength index, and ISI) remained significant after adjustment for weight. In conclusion, the current study suggests that the free vitamin D serum level is a stronger positive determinant of bone parameters and hip bone strength indices in young female adults than total serum vitamin D.

Lumbar Spondylodiscitis Caused by Burkholderia cepacia in a Previously Healthy Patient.

Burkholderia cepacia spondylodiscitis is a rare entity that has been reported in only four cases. We hereby report the case of a 43-year-old, previously healthy, woman who was found to have a B. cepacia spondylodiscitis after a cholecystectomy. She was treated with a three-month regimen of ceftazidime and ciprofloxacin with complete clinical, biological, and radiological remission.

Fracture liaison service: report on the first successful experience from the Middle East.

This study aims to assess for the first time in the Middle East, the clinical benefits of an FLS model established in a hospital in Beirut, Lebanon. It shows a significant 54% relative risk reduction in re-fracture incidence, confirming the patient-oriented benefit of diffusing this system in the Middle East region. PURPOSE/INTRODUCTION: Few hospitals in Lebanon applied Fracture Liaison Service (FLS) program. A type A FLS is established at Bellevue hospital in Beirut in July 2013. This study aims to assess its clinical benefits and efficacy. METHODS: Patients aged 50 years and above presenting to our hospital with minimal trauma fracture from July 2012 till June 2014 are enrolled. These are divided into two groups, before (group A) and after (group B) FLS implementation. Both groups are compared for re-fracture incidence, bone health assessment; osteoporosis treatment maintenance, and death in a 2-year follow-up. RESULTS: Nighty-eight patient composing group B are compared to 100 patients in the group A. Around 65% of patients in the FLS group underwent Dexa osteodensitometry following their fracture compared to 28% in the comparator group (p < 0.001). About 54% of patients in group B maintained osteoporosis treatment compared to 26% in group A (p < 0.001). Sixteen percent of patients died in the FLS study group compared to 16% of patients in the comparator group (p = 0.950). A second fracture, happened in 8.2% of patients in the FLS study group compared to 18% of the patients in the comparator group p = 0.004. Number needed to treat reached 10.2 patients. CONCLUSIONS: The statistical analysis results go with the overwhelming evidence concerning FLS importance in promoting bone health assessment and osteoporosis treatment in fracture patients. It also confirms the clinical value and the patient-oriented benefit of an implementation of such a system.

Surveillance of antimicrobial resistance in Lebanese hospitals: retrospective nationwide compiled data.

Antimicrobial resistance is closely linked to antimicrobial use and is a growing concern worldwide. Antimicrobial resistance increases healthcare costs substantially in many countries, including Lebanon. National data from Lebanon have, in the most part, been limited to a few academic hospitals. The Lebanese Society of Infectious Diseases conducted a retrospective study to better describe the antimicrobial susceptibility patterns of bacterial isolates in Lebanon. Data were based on records retrieved from the bacteriology laboratories of 16 different Lebanese hospitals between January 2011 and December 2013. The susceptibility results of a total 20684 Gram-positive and 55594 Gram-negative bacteria were analyzed. The prevalence rate of methicillin-resistant Staphylococcus aureus was 27.6% and of vancomycin-resistant Enterococcus spp was 1%. Streptococcus pneumoniae had susceptibilities of 46% to oxacillin, 63% to erythromycin, and 98% to levofloxacin. Streptococcus pyogenes had susceptibilities of 94% to erythromycin and 95% to clindamycin. The mean ampicillin susceptibility of Haemophilus influenzae, Salmonella spp, and Shigella spp isolates was 79%, 81.3%, and 62.2%, respectively. The extended-spectrum beta-lactamase production rate for Escherichia coli was 32.3% and for Klebsiella spp was 29.2%. Acinetobacter spp showed high resistance to most antimicrobials, with low resistance to colistin (17.1%). Pseudomonas spp susceptibilities to piperacillin-tazobactam and imipenem were lower than 80% (79.7% and 72.8%, respectively). This study provides population-specific data that are valuable in guiding antimicrobial use in Lebanon and neighbouring countries and will help in the establishment of a surveillance system for antimicrobial resistance following the implementation of a nationwide standardization of laboratory methods and data entry.