Risk factors associated with prolonged nasopharyngeal carriage of SARS-CoV-2 and length of stay among patients admitted to a COVID-19 referral center in Manila, Philippines

Objective@#Prolonged nasopharyngeal carriage of SARS-CoV-2 has been linked to prolonged hospital stay and delayed radiologic recovery. To determine if clinical risk factors are associated with prolonged nasopharyngeal carriage or longer hospital stay, we performed a descriptive analysis of 169 moderate to severe COVID-19 patients admitted at the Philippine General Hospital from March to June 2020.@*Methods@#Length of nasopharyngeal RT-PCR positivity and clinical demographic data were extracted from existing patient records. Chi-square test, Mann-Whitney U test, and regression analysis were performed to describe the association of clinical risk factors with prolonged nasopharyngeal carriage and length of hospital stay.@*Results@#The median duration of carriage was 19 days (IQR 12.0-30.0 days). No comorbidities or inflammatory markers had a statistically significant association with prolonged nasopharyngeal carriage defined as >24 days of nasopharyngeal RT-PCR positivity. Characteristics associated with a statistically significant longer hospital stay included chronic kidney disease stages 3-5, severe disease, and use of empiric antibiotics on admission. Prolonged carriage >24 days, hsCRP, and D-dimer at admission, also had a statistically significant but weak correlation with length of stay.@*Conclusion@#Among patients with moderate disease, comorbidities and inflammatory markers were not associated with prolonged COVID-19 nasopharyngeal carriage. Prolonged nasopharyngeal carriage >24 days was associated with longer hospital stay, while D-dimer and hsCRP levels at admission, also had statistically significant but small effects on increasing the hospital length of stay.

Risk factors associated with prolonged Nasopharyngeal carriage of SARS-CoV-2 and length of stay among patients admitted to a COVID-19 referral center in Manila, Philippines

Objective@#Prolonged nasopharyngeal carriage of SARS-CoV-2 has been linked to prolonged hospital stay and delayed radiologic recovery. To determine if clinical risk factors are associated with prolonged nasopharyngeal carriage or longer hospital stay, we performed a descriptive analysis of 169 moderate to severe COVID-19 patients admitted at the Philippine General Hospital from March to June 2020. @*Methods@#Length of nasopharyngeal RT-PCR positivity and clinical demographic data were extracted from existing patient records. Chi-square test, Mann-Whitney U test, and regression analysis were performed to describe the association of clinical risk factors with prolonged nasopharyngeal carriage and length of hospital stay. @*Results@#The median duration of carriage was 19 days (IQR 12.0-30.0 days). No comorbidities or inflammatory markers had a statistically significant association with prolonged nasopharyngeal carriage defined as >24 days of nasopharyngeal RT-PCR positivity. Characteristics associated with a statistically significant longer hospital stay included chronic kidney disease stages 3-5, severe disease, and use of empiric antibiotics on admission. Prolonged carriage >24 days, hsCRP, and D-dimer at admission, also had a statistically significant but weak correlation with length of stay. @*Conclusion@#Among patients with moderate disease, comorbidities and inflammatory markers were not associated with prolonged COVID-19 nasopharyngeal carriage. Prolonged nasopharyngeal carriage >24 days was associated with longer hospital stay, while D-dimer and hsCRP levels at admission, also had statistically significant but small effects on increasing the hospital length of stay

Evaluation of Haemophilus influenzae type b carrier status among children 10 years after the introduction of Hib vaccine in Brazil

The aim of the present study was to assess the prevalence of Haemophilus influenzaetype b (Hib) nasopharyngeal (NP) colonisation among healthy children where Hib vaccination using a 3p+0 dosing schedule has been routinely administered for 10 years with sustained coverage (> 90%). NP swabs were collected from 2,558 children who had received the Hib vaccine, of whom 1,379 were 12-< 24 months (m) old and 1,179 were 48-< 60 m old. Hi strains were identified by molecular methods. Hi carriage prevalence was 45.1% (1,153/2,558) and the prevalence in the 12-< 24 m and 48-< 60 m age groups were 37.5% (517/1,379) and 53.9% (636/1,179), respectively. Hib was identified in 0.6% (16/2,558) of all children in the study, being 0.8% (11/1,379) and 0.4% (5/1,179) among the 12-< 24 m and 48-< 60 m age groups, respectively. The nonencapsulate Hi colonisation was 43% (n = 1,099) and was significantly more frequent at 48-< 60 m of age (51.6%, n = 608) compared with that at 12-< 24 m of age (35.6%, n = 491). The overall resistance rates to ampicillin and chloramphenicol were 16.5% and 3.7%, respectively; the co-resistance was detected in 2.6%. Our findings showed that the Hib carrier rate in healthy children under five years was very low after 10 years of the introduction of the Hib vaccine.

Nasopharyngyeal Carriage and Antimicrobial Susceptibility of Streptococcus pneumoniae, in Children under Five Years at Mbarara Regional Referral Hospital, Uganda.

Background: Acute respiratory infections (ARI) are a leading cause of childhood morbidity and mortality, causing 25-30% of all deaths in developing countries. Pneumococcal disease is a significant public health problem that usually follows pneumococcal colonization of the nasopharynix. We determined the prevalence of nasopharyngeal carriage of Streptococcus pneumoniae, antimicrobial susceptibility patterns and risk factors for nasopharyngeal carriage of S. pneumoniae among under fives attending Maternal Child Health Clinic at Mbarara Regional Referral Hospital (MRRH). Methods: We performed a cross-sectional study between August and November 2012. Nasopharyngeal swabs collected from four hundred healthy children were cultured on blood agar and chocolate agar and incubated for 24 hours at 37⁰C in carbon dioxide jar. Upon growth the organisms were identified by colonial appearance and standard biochemical tests. Antimicrobial resistance to six antibiotics was performed using Kirby Bauer method on chocolate agar and interpreted according to CLSI guide lines. Results: The prevalence of S. pneumoniae in the cultured samples was reported at 19% (76/400). Of the positive isolates, 75/76 (99%) and 55/76 (77%) were shown to be resistant to cotrimoxazole and tetracycline, respectively. Among the factors assessed for nasopharyngeal carriage of S. pneumoniae none was significantly associated with carriage. Conclusion: Despite the low rate of carriers of S. pneumoniae, a remarkable resistance of these isolates to cotrimoxazole and tetracycline was detected.

Nasopharyngeal carriage, antibiogram & serotype distribution of Streptococcus pneumoniae among healthy under five children.

Background & objectives: Information related to nasopharyngeal carriage of Streptococcus pneumoniae among healthy children is scanty in India. This prospective study was undertaken to determine the presence of asymptomatic nasopharyngeal colonization, assess serogroups/types (SGT) and drug resistance of S. pneumoniae in children below five years of age. Methods: A total of 109 male and 81 female children in the age group of three months to five years belonging to different socio-economic classes were enrolled. They were recruited across all age groups from those attending paediatric OPD of a tertiary care and research centre for immunization program. Fifty three isolates identified as pneumococci were tested for their antimicrobial susceptibility pattern by Kirby-Bauer’s disc diffusion and E-Test methods. Serotyping was performed by detection of the quelling reaction with specific antiserum. Result: The pneumococcal carriage rate in the study population was 27.9 per cent. The isolation rate was associated with age being higher (49.2%) in smaller children (3-12 months) and among male (62.2%). The most prevalent SGTs were 19 followed by 10, 14 and 7; 21 per cent of isolates belonging to serotype 10 (n=7) were 11 (n=4) were not covered in any of the conjugate vaccines currently available in Indian market. Resistance to co-trimoxazole, tetracycline, penicillin and erythromycin was observed in 91 per cent (n=48), 36 per cent (n=19), 17 per cent (n=9) and 9 per cent (n=5) isolates, respectively. All the penicillin resistant isolates were found to be intermediately resistant by E-Test. Multidrug resistance was observed in 19 per cent (n=10) isolates. Interpretation & conclusions: High level of antibiotic resistance was present in S. pneumoniae isolated from healthy children below age five. A pneumococcal conjugate vaccine with the prevailing SGTs would help to reduce the pool of antibiotic resistant pneumococci. Continued surveillance of serotypes and tracking susceptibility pattern of S. pneumoniae will help to introduce appropriate vaccination protocols.

Colonização Nasofaringeana por streptococcus pneumoniae: estudo lngitudinal em crianças menores de cinco anos de idade / Colonization nasopharyngeal by Streptococcus pneumoniae: longitudinal study in children under Five years old

Streptococcus pneumoniae é um dos agentes etiológicos mais importantes em infecções adquiridas na comunidade. Este patógeno coloniza o trato respiratório de indivíduos saudáveis, apresentando maior prevalência entre 1 e 2 anos de idade (aproximadamente 50%) e depois diminui com a idade adulta (aproximadamente 10%). A alta incidência das doenças pneumocócicas e a crescente resistência aos antimicrobianos, favoreceu a introdução das vacinas conjugadas (ano de 2000). Após a introdução das vacinas conjugadas foi observado à queda na incidência da doença pneumocócica e diminuição da prevalência de colonização por sorotipos vacinais. Em contrapartida vem sendo notado o aumento de casos de doença sorotipos não vacinais. Por isso a importância de verificar a dinâmica da colonização nasofaringeana por pneumococos em crianças < 5 anos de idade antes da introdução da vacina. Foram selecionadas radomicamente 203 crianças residentes da comunidade de Pau da Lima, Salvador, Bahia, das quais foi colhido a amostra nasofaringeana em quatro períodos durante um ano com intervalo de três a quatro meses entre cada coleta. No período de janeiro de 2008 a janeiro de 2009 foram colhidos um total de 721 swabs, sendo 398 positivos para pneumococos (56%)...

Streptococcus pneumoniae is one of the most important etiologic agents in community-acquired infections. This pathogen colonizes the respiratory tract of healthy individuals shortly after birth, with higher prevalence of between 1 and 2 years of age (approximately 50%) and then decreases with age reaching adult rates below 10%. The high incidence and increasing antimicrobial resistance, favored the introduction of conjugate vaccines in 2000. After the introduction of conjugate vaccines a decreasing incidence of pneumococcal disease and carriage rates by vaccine serotypes was observed. In contrast we observe an increase in number of cases of disease and carriage by non-vaccine serotypes. Thus, this study aims to determine the dynamics of nasopharyngeal colonization by pneumococci in children <5 years of age after introduced the conjugate vaccine. A total of 203 children were random selected at the community of Pau da Lima in Salvador, Bahia, of whom the nasopharyngeal swab was collected in four periods with interval of 3 to 4 months between each collection. A total of 721 swabs were collected from January 2008 to January 2009, with 398 positive for pneumococci (56%)...

Streptococcus pneumoniae isolates in healthy children attending day-care centers in 12 states in Mexico

OBJECTIVE: The aim of this study was to determine the prevalence of asymptomatic nasopharyngeal carriage of Streptococcus pneumoniae, which is a major factor in the transmission of this bacterium. MATERIAL AND METHODS: Nasopharyngeal cultures were performed on children attending 32 day-care centers in 12 states in Mexico. RESULTS: Streptococcus pneumoniae was isolated from the nasopharynx of 829 out of 2 777(29.9 percent) subjects aged two months to six years. All children lived in urban areas and 80 percent spent more than six hours daily in a day-care center. Streptococcus pneumoniae serotypes most frequently identified were: 19F (23 percent), 6B (15.6 percent), 23F (11.2 percent) and 6A (14.9 percent). Thirty-six percent of the isolates were susceptible to penicillin. CONCLUSIONS: Serotype distribution suggests the possible benefits that could be obtained from the heptavalent pneumococcal conjugate vaccine.

OBJETIVO: La intención de este estudio fue determinar la prevalencia de portadores nasofaríngeos asintomáticos de Streptococcus pneumoniae, el cual es el principal factor en la transmisión de esta bacteria. MATERIAL Y MÉTODOS: Los cultivos nasofaríngeos fueron realizados en niños que asisten a 32 estancias infantiles en 12 estados de México. RESULTADOS: Streptococcus pneumoniae fue aislado de la nasofaringe de 829 (29.9 por ciento) niños de los 2 777 incluidos en el estudio con un rango de edad de 2 meses a 6 años. Todos los niños vivían en áreas urbanas y 80 por ciento permanecían más de seis horas diarias en la estancia infantil. Los serotipos de Streptococcus pneumoniae más frecuentemente identificados fueron: 19F (23 por ciento), 6B (15.6 por ciento), 23F (11.2 por ciento) y 6 A (14.9 por ciento). Treinta y seis por ciento de los aislamientos fueron susceptibles a penicilina. CONCLUSIONES: La distribución de serotipos nos da una idea de los posibles beneficios que podrían obtenerse de la vacuna neumocóccica conjugada heptavalente.

Surveillance for antimicrobial resistance of Streptococcus pneumoniae among children attending day care center in Seoul, Korea / 대한임상병리학회지

BACKGROUND: Multidrug-resistant Streptococcus pneumoniae occasionally cause treatment failure in various pneumococcal infection in children. The pneumococcal strains carried at the nosopharynx are frequently found at the time of invasive infection in one individual. We investigated the prevalence of nasopharyngeal carriage of S. pneumoniae and antibiotic susceptibility patterns among children attending day care center and compared the rates of antibiotic resistance of those strains with strains recovered from clinical specimens of patients at a tertiary care hospital. METHODS: Two-hundred nine children from 3 centers distributed at Jong-Ro area of Seoul, Korea were enrolled from May to June, 1998. Swabs were obtained from posterior nasopharynx and cultured onto tryptic soy agar containing 5% sheep blood without and with 10 microgram/mL gentamicin for 24 hours. Clinical isolates included the non-invasive isolates from sputum, ear discharge and sinus aspirate and the invasive isolates from cerebrospinal fluid and blood. Antimicrobial susceptibilities were determined with E-test and agar dilution method. RESULTS: The overall prevalence of nasopharyngeal carriage was 32.5%(68/209). The children >4, 5< OR = years of age have the highest carriage rate(36.7%). But there were no significant differences of prevalence in gender and centers. The prevalences of decreased antibiotic susceptibilities in the nasopharyngeal isolates and clinical isolates were, respectively: penicillin(75% vs 86%, NS); cefotaxime(20% vs 48%, p<0.05); multiresistance(57% vs 86%, p<0.05). Younger the age and female in gender, higher the resistance rate to penicillin. CONCLUSIONS: There was no significant difference in antimicrobial resistance of pneumococci between healthy nosopharyngeal carriages and clinical isolates causing invasive or non-invasive infections. The results acquired from this surveillence would provide a useful guide in an appropriate choice of antimicrobial agents for management of pneumococcal diseases.