Impact of PCV10 on pediatric pneumococcal disease burden in Brazil: time for new recommendations?

Abstract Objective: To describe the impact of the 10-valent pneumococcal conjugate vaccine on the pediatric burden of pneumococcal infections, carriage, serotype replacement, and antimicrobial resistance in Brazil since its introduction in 2010. Data source: A narrative review of English, Spanish, and Portuguese articles published in online databases and in Brazilian epidemiological surveillance databases was performed. The following keywords were used: Streptococcus pneumoniae, pneumococcal disease, conjugate vaccine, PCV10, antimicrobial resistance, and meningitis. Summary of the findings: Declines in hospitalization rates of all-cause pneumonia occurred in the target age groups and some age groups not targeted by vaccination early after the use of PCV10. Large descriptive studies of laboratory-confirmed pneumococcal meningitis and hospital-based historical series of hospitalized children with IPD have evidenced a significant impact on disease burden, in-hospital fatality rates, and admission to the intensive care unit before and after the inclusion of the vaccine. Impact data on otitis media is limited and inconsistent; the main benefit remains the prevention of complicated diseases. During the late post-vaccine years, a significant and progressive increase in high-level penicillin non-susceptibility pneumococci has been described. Since 2014 serotype 19A has been the leading serotype in all ages and was responsible for 28.2%-44.6% of all IPD in children under 5 yrs. Conclusions: PCV10 has performed a significant impact on IPD in Brazil since 2010, however, progress has been continuously hampered by replacement. Broader spectrum PCVs could provide expanded direct and indirect protection against ST19A and other additional serotypes of increasing importance if administered to children in the Brazilian National Immunization Program.

UTI among patients attending IPD and its relation with preterm labor in Bangabandhu Sheikh Mujib Medical College Hospital, Faridpur

Background: Urinary tract infections (UTIs) now have become a severe public health problem because of the morbidity and treatment cost. UTI can be occur in all age groups, but women are more prone to develop UTI in comparison to men, due to several factors like short urethra, absence of prostatic secretions, pregnancy and easy infection in the urinary tract with fecal flora.Material & Methods:This study was a retrospective cross-sectional study which was conducted at the department of Obstetrics and Gynaecology, Bangabandhu Sheikh Muzib medical college hospital, Faridpur, Bangladesh. The study was conducted during the period of January 2021- January 2022. The total sample size for this study was 197.Results:Most of the respondents 87(44.2%) were aged between 25-29 years and followed by 16(8.1%) were aged 20-24 years, 81(41.1%) were 30-34 years and 13(6.6%) were aged >34 years. According to gravida, 4th gravida were 65(33.0%), 3rd gravida 37(18.8%), 2nd gravida 62(31.5%) and 1st gravida were 33(16.8%). The most common isolated organism was E. coli which was found in 135(68.5%) cases and followed by S. Aureus in 21(10.7%), Coagulase negative staph in 20(10.2%), Klebsiella in 9(4.6%) and GBS in 12(6.1%) cases. Majority of the patients 192(97%) had no complications onwards and only 5(3%) case was found with pyelonephritis.Conclusion: UTI in pregnancy has a major influence on pregnancy outcome. The unsolicited miseries of the pregnant mothers and their progenies might easily be legitimate by early diagnosis and treatment of UTI during pregnancy.

Comparison of the clinical features of invasive pneumococcal disease with those of pneumococcal pneumonia in adults / Journal of Rural Medicine

Background: Invasive pneumococcal disease (IPD) is an infectious disease where Streptococcus pneumoniae can be detected in the cerebrospinal fluid or blood.Methods: Eight patients presented to our hospital with adult IPD. We compared with 69 cases of pneumococcal pneumonia treated in our department between 2012 and 2014. None of the patients had a history of pneumococcal vaccine administration.Results: Hematological examination showed the platelet count was significantly lower and the serum C-reactive protein level was significantly higher in the IPD group. There was a significant difference in the use of a respirator and mortality in the IPD group. About antibiotics, Carbapenem and quinolone were used for the treatment of many patients in the IPD group. In the fatal three cases of IPD, the age of all members were 65 years or younger. Two of three had no underlying disease.Conclusion: IPD develops without elderly people and in those without underlying disease. Also, the patients who took a sudden course may result in death. In line with previous studies that have reported the effectiveness of the pneumococcal vaccine, our study findings emphasize the need of administering vaccination for prevention of IPD in person who was younger than 65 years old.

Pediatric bacterial meningitis and meningococcal disease profile in a Brazilian General Hospital

Abstract Objective To evaluate the clinical and epidemiological profile of bacterial meningitis and meningococcal disease in pediatric patients admitted to a Brazilian Secondary Public Hospital. Methods A descriptive observational study was conducted. Microbiologically proven bacterial meningitis or meningococcal disease diagnosed from 2008 to 2018 were included. Results A total of 90 patients were diagnosed with proven bacterial meningitis. There were 64 confirmed cases of meningococcal disease. The prevalence was higher in boys (n=38), median age 30 months (1-185). The main clinical manifestations were: meningococcal meningitis (n=27), meningococcemia without meningitis (n=14), association of meningococcemia with meningitis (n=13), and fever without a known source in infants (n=7).Admissions to intensive care unit were necessary for 45 patients. Three deaths were notified. Serogroup C was the most prevalent (n=32) followed by serogroup B (n=12).Pneumococcal meningitis was identified in 21 cases; out of the total, 10 were younger than two years. The identified serotypes were: 18C, 6B, 15A, 28, 7F, 12F, 15C, 19A and 14. Pneumococcal conjugate 10-valent vaccine covered four of the nine identified serotypes.Haemophilus influenzae meningitis serotype IIa was identified in three patients, median age 4 months (4-7). All of them needed intensive care. No deaths were notified. Conclusion Morbidity and mortality rates from bacterial meningitis and meningococcal disease remain high, requiring hospitalization and leading to sequelae. Our study observed a reduced incidence of bacterial disease over the last decade, possibly reflecting the impact of vaccination.

Safety and efficacy of a novel drug elores (ceftriaxone + sulbactam + disodium edetate) in the management of multi-drug resistant bacterial infections in tertiary care centers: a post-marketing surveillance study

Abstract Objective: In India, Elores (CSE-1034: ceftriaxone + sulbactam + disodium edetate) was approved as a broad spectrum antibiotic in year 2011 and is used for management of Extended Spectrum Beta Lactamases/Metallo Beta lactamases infections in tertiary care centers. The objective of this study was to investigate the efficacy of this drug in patients with Extended Spectrum Beta Lactamases/Metallo Beta lactamases infections and identify the incidence of adverse events in real clinical settings. Methods: This Post Marketing Surveillance study was conducted at 17 centers across India and included 2500 patients of all age groups suffering from various bacterial infections and treated with Elores (CSE1034). Information regarding demographic, clinical and microbiological parameters, dosage and treatment duration, efficacy and adverse events (AEs) associated with the treatment were recorded. Results: A total of 2500 patients were included in the study and efficacy was evaluated in 2487 patients. In total, 409 AEs were reported in 211 (8.4%) patients. The major AEs reported were vomiting (3.0%), pain at injection site (2.5%), nausea (2.3%), redness at site (1.96%), thrombophlebitis (1.4%). Of total reported AEs, 40 (5.3%) AEs were reported in pediatric, 310 (20.6%) in adult, and 59 (23.6%) in geriatric group. No AE belonging to grade IV or V was reported in any patient. In terms of efficacy, 1977 (79.4%) patients were cured, 501 (20.1%) patients showed clinical improvement and 5 (0.2%) patients were complete failure. The treatment duration varied from 5 to 7 days in different patients depending on the infection type. Conclusion: In this post-marketing surveillance study, CSE-1034 was found to be an effective and safe option against Pip tazo and meropenem in management of patients with multi-drug resistant (MDR) bacterial infections under routine ward settings.

Pharmacoepidemiology of drugs utilized in ophthalmic outpatient and inpatient department of a tertiary care hospital.

Periodical auditing of drug utilization is vital for promotion of rational use of drugs. So for pharmacoepidemiological analysis of the drugs, utilized in eye OPD and IPD, a study was conducted prospectively for six months, in the Department of ophthalmology and pharmacology. Data were collected, from the prescription form of patients in OPD and from the bed head tickets of patients in IPD. Various parameters of utilization pattern were evaluated. The maximum number of patients belongs to age group of 46-60 years and lower middle class of socioeconomic status but there was no sex preponderance. Dosage, frequency and duration of therapy were recorded in more than 89% of prescriptions. An average number of drugs per prescription were 2.69 and 3.2; drugs prescribed by their generic names were 26.04% and 35.33%; fixed dose combinations prescribed were 36.98% and 67.29% and polypharmacy found were 23.3% and 11.47% of prescription in OPD and IPD respectively. The commonest dosage forms were eye drops in OPD and injections in IPD. More than 80% of the drugs were prescribed from hospital pharmacy. Average total cost per prescription was 87.40 INR in OPD and 135.80 INR in IPD but it was free of cost from hospital pharmacy.

A Case of Small Bowel Perforation Associated with Sclerosing Encapsulating Peritonitis in Patient with Intermittent Peritoneal Dialysis (IPD) / 대한신장학회잡지

Sclerosing ecapsulating peritonitis (SEP) first described by Gandhi and Humyn at 1980 is generally recognized, but uncommon complication of continous ambulatory peritoneal dialysis (CAPD) and the prognosis is very poor. A 62-year old female was admitted to our hospital with chief complaint of abdominal pain, nausea, vomiting. On physical examination, abdominal pain was not detected. Abdominal CT demonstrated paralytic ileus and adhesion in proximal ileum. She underwent adhesilolysis of ileum and repair of perforated ileum. We experienced one case of SEP presenting small bowel perforation and peritonitis in patient with IPD. We report this case with review of the literature.

Determination of netilmicin sulfate in serum by high performance liquid chromatography-indirect photometric determination method / 中国药学杂志

OBJECTIVE: To determine the content of netilmicin sulfate in serum by a high performance liquid chromatography-indirect photometric determination (HPLC-IPD) method. METHOD: The chromatographic system consisted of Soheisorb C18 column and mobile phase of a solution of methyl alcohol-a buffer of phosphoric acid (pH=2.0) (20∶80), that contained 0.5 mmolL-1 of nicotinamide and 0.3 mmolL-1 of sodium seventhalkyl-sulphonate. The detected wave length was 268 nm. The serum simple of 4 patients was determined. RESULTS: The mean recovery of was 93.41% and detection limits was 50 μgL-1. CONCLUSION: The method is constant, sensitive, and has a good concentration. It is good for determination of netilmicin sulfate concentration in serum.