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@#BACKGROUND: Streptococcus pneumoniae (S. pneumoniae) is a common pathogen that causes bacterial pneumonia. However, with increasing bacterial resistance, there is an urgent need to develop new drugs to treat S. pneumoniae infections. Nanodefensin with a 14-carbon saturated fatty acid (ND-C14) is a novel nanoantimicrobial peptide designed by modifying myristic acid at the C-terminus of human α-defensin 5 (HD5) via an amide bond. However, it is unclear whether ND-C14 is effective against lung infections caused by S. pneumoniae. METHODS: In vitro, three groups were established, including the control group, and the HD5 and ND-C14 treatment groups. A virtual colony-count assay was used to evaluate the antibacterial activity of HD5 and ND-C14 against S. pneumoniae. The morphological changes of S. pneumoniae treated with HD5 or ND-C14 were observed by scanning electron microscopy. In vivo, mice were divided into sham, vehicle, and ND-C14 treatment groups. Mice in the sham group were treated with 25 µL of phosphate-buffered saline (PBS). Mice in the vehicle and ND-C14 treatment groups were treated with intratracheal instillation of 25 µL of bacterial suspension with 2×108 CFU/mL (total bacterial count: 5×106 CFU), and then the mice were given 25 μL PBS or intratracheally injected with 25 μL of ND-C14 (including 20 µg or 50 µg), respectively. Survival rates were evaluated in the vehicle and ND-C14 treatment groups. Bacterial burden in the blood and bronchoalveolar lavage fluid were counted. The lung histology of the mice was assessed. A propidium iodide uptake assay was used to clarify the destructive effect of ND-C14 against S. pneumoniae. RESULTS: Compared with HD5, ND-C14 had a better bactericidal effect against S. pneumoniae because of its stronger ability to destroy the membrane structure of S. pneumoniae in vitro. In vivo, ND-C14 significantly delayed the death time and improved the survival rate of mice infected with S. pneumoniae. ND-C14 reduced bacterial burden and lung tissue injury. Moreover, ND-C14 had a membrane permeation effect on S. pneumoniae, and its destructive ability increased with increasing ND-C14 concentration.
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El síndrome hemolítico urémico secundario a Streptococcus pneumoniae (SHU-Sp) es una complicación poco frecuente de las enfermedades invasoras por S. pneumoniae. Presenta una alta morbimortalidad, con requerimiento de transfusiones de glóbulos rojos y plaquetas, terapia de sustitución de la función renal de inicio precoz y más prolongada, así como mayores complicaciones a largo plazo, comparado con las formas secundarias a infección entérica por Escherichia coli productora de toxina Shiga. Presentamos el caso clínico de una preescolar de dos años, previamente sana, vacunada con tres dosis de PCV13, que desarrolló una insuficiencia renal aguda, anemia hemolítica y plaquetopenia, en el contexto de una neumonía con empiema y bacteriemia por S. pneumoniae.
Streptococcus pneumoniae associated hemolytic uremic syndrome (Sp-HUS) is an uncommon complication of invasive pneumococcal infections. Patients with Sp-HUS have a higher mortality and long term morbidity than those due to HUS from Shiga toxin-producing Escherichia coli infections (STEC-HUS). They often require more red blood cells and platelet transfusions, and early initiation of renal substitution therapy, presenting a higher rate of arterial hypertension and chronic renal disease in the long term, compared to STEC-HUS. We report a healthy 2 year-old infant, vaccinated with three doses PCV13, that developed acute renal failure, hemolytic anemia and thrombocytopenia in the course of a complicated pneumococcal pneumonia with empyema and bacteremia.
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Introducción: La infección por Streptococcus pneumoniae constituye una causa importante de morbimortalidad en el mundo, sobre todo en niños menores de 5 años, en los que ocasiona de 1 a 2 millones de muertes anuales. Objetivo: Determinar la presencia de S. pneumoniae en muestras clínicas obtenidas en niños. Métodos: Se realizó un estudio descriptivo y transversal en niños menores de 5 años de edad con diagnóstico clínico de enfermedad neumocócica invasiva, asistidos en dos hospitales pediátricos de Santiago de Cuba durante el periodo 2014-2018. De las 1466 muestras clínicas tomadas y procesadas, en 131 fue aislado el agente patógeno; estas correspondieron a 59 pacientes con formas clínicas de la infección y 72 portadores. Para el procesamiento estadístico de la información se utilizaron las frecuencias absoluta y relativa como medidas de resumen. Resultados: En general, la positividad por S. pneumoniae fue de 8,9 %, con mayores frecuencias de aislamiento en las muestras de líquido cefalorraquídeo (81,8 %), líquido pleural (47,1 %) y exudado ótico (21,9 %), que asimismo coincidieron con los porcentajes más elevados de neumonía (61,0), otitis media aguda (23,7) y meningitis (15,3), como formas clínicas de la enfermedad neumocócica, que aquejó principalmente a niños de 1 año de edad, seguidos de los mayores de 2 años. De igual modo, se identificaron 9 serotipos de S. pneumoniae, con predominio del 19A (39,0 %), el 14 (25,4 %) y el 6A (11,9 %). En los pacientes que portaban la bacteria en la nasofaringe se identificaron 8 tipos serológicos, predominantemente el 19A y el 14. Por último, se halló una alta resistencia microbiana a la eritromicina y a la combinación trimetoprima-sulfametoxazol. Conclusiones: Los resultados de este estudio proporcionaron un referente científico antes de la introducción de la vacuna antineumocócica cubana, lo que permitirá evaluar su impacto en la incidencia de dicha enfermedad.
Introduction: The infection due to Streptococcus pneumoniae constitutes an important cause of morbimortality in the world, mainly in children under 5 years, that causes from 1 to 2 million annual deaths. Objective: To determine the presence of S. pneumoniae in clinical samples obtained in children. Methods: A descriptive and cross-sectional study was carried out in children under 5 years with clinical diagnosis of invasive pneumococcus disease, assisted in two children hospitals from Santiago de Cuba during the period 2014-2018. Of the 1466 clinical samples taken and processed, in 131 the pathogen agent was isolated; these corresponded to 59 patients with clinical forms of the infection and 72 carriers of the disease. For the statistical processing of the information the absolute and relative frequencies were used as summary measures. Results: In general the positivity for S. pneumoniae was of 8.9 %, with more isolation frequencies in the samples of cerebrospinal fluid (81.8 %), pleural fluid (47.1 %) and otic exudate (21.9 %) that also coincided with the highest percentages of pneumonia (61.0), acute otitis media (23.7) and meningitis (15.3), as clinical forms of the neumococcus disease that mainly affected 1 year children, followed by those over 2 years. In a same way, 9 serotypes of S. pneumoniae were identified, with prevalence of the 19A (39.0 %), and 14 (25.4 %) and the 6A (11.9 %). In the nasopharyngeal carriers 8 serotypes were identified, of which the 19A and 14 prevailed. Lastly, a high microbian resistance to erythromycin and the combination trimethoprim-sulfametoxazole was found. Conclusions: The results of this study provided a scientific referent before the introduction of the Cuban antipneumococcus vaccine that will allow to evaluate its impact in the incidence of this disease.
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Infecções PneumocócicasRESUMO
Resumen La peritonitis por neumococo comprende un pequeno subconjunto de pacientes con enfermedad invasiva (ENI). Durante 15 años (2005-2020) de vigilancia de ENI en un hospital de pediatría, se detectaron 5 casos de peritonitis primaria. Los pacientes, 3 ninas y 2ninos con una media de edad de 5 anos, experimentaron signos y síntomas peritoneales; 3 de ellos presentaban síndrome nefrótico. En coincidencia con los perfiles locales, todos los aislamientos fueron sensibles a betalactámicos, una cepa expresó resistencia a tetraciclina y cotrimoxazol y otra solo a cotrimoxazol. Los serotipos encontrados en 4/5 cepas (una resultó no viable) fueron 1, 19F, 15C y 23A. Los ninos fueron tratados con cefalosporinas de tercera generación o con ampicilina, gentamicina y metronidazol; todos evolucionaron favorablemente. Se destaca la importancia del hallazgo de Streptococcus pneumoniae en peritonitis primarias en niños. Este trabajo contribuye al conocimiento de esta enfermedad en particular y al de la epidemiología local de la ENI.
Abstract Pneumococcal peritonitis represents a small subset of patients suffering from inva-sive pneumococcal disease (IPD). We describe 5 cases of primary peritonitis documented in the pediatric hospital over 15 years (2005-2020) of IPD surveillance. The patients, 3girls and 2boys with a mean age of 5 years, experienced peritoneal signs and symptoms; 3of them suffered from nephrotic syndrome. Based on the local resistance profiles, all isolates were sensitive to beta-lactams, one strain showed resistance to cotrimoxazole and tetracycline while another strain, to cotrimoxazole only. Serotypes found in 4/5 strains (one was non-viable) were: 1, 19F, 15C and 23A. Children were treated with third-generation cephalosporins or ampicillin, gentamicin and metronidazole and all of them evolved favorably. Pneumococcal etiology should be included in the differential diagnosis of acute abdominal pain in children. Our study aims to contribute to the knowledge of this condition and to the local epidemiology of IPD.
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Introducción: La neumonía adquirida en la comunidad es una de las enfermedades con mayor prevalencia en la comunidad pediátrica en nuestro país. De las diferentes etiologías que pueden causarlas, la neumonía ocasionada por Streptococcus pneumoniae puede ser prevenida con el uso de inmunización. Actualmente se disponen de tres tipos de vacunas antineumocócicas conjugadas autorizadas de uso pediátrico de forma sistemática. Objetivo: Identificar la prevalencia de neumonía bacteriana en niños bajo 5 años de edad, que requirieron hospitalización comparando la vacuna neumocócica recibida: 10 valente (PCV10) versus 13 valente (PCV13). Pacientes y Métodos: Estudio de descriptivo, retrospectivo. Se incluyeron pacientes hospitalizados bajo 5 años de edad, con diagnóstico de neumonía bacteriana mediante codificación CIE10 en un hospital de tercer nivel de la ciudad de Quito-Ecuador, durante el año 2019. Resultados: Se estudiaron 175 pacientes de los cuales 74 cumplieron con criterios clínicos de neumonía, de estos 46 recibieron PCV10 y 28 recibieron vacuna PCV13. Discusión y Conclusiones: La prevalencia de neumonía bacteriana fue mayor en los pacientes inmunizados con PCV10 lo que sugiere una relación de menor probabilidad de neumonía con el uso de la vacuna PCV13.
Background: Community-acquired pneumonia is one of the most prevalent diseases in the pediatric community in our country, of the different etiologies that can cause them, pneumonia caused by Streptococcus pneumoniae can be prevented with the use of immunization. Currently there are three types of authorized pneumococcal conjugate vaccines for pediatric use in a systematic way. Aim: To identify the prevalence of bacterial pneumonia in children under 5 years of age who required hospitalization by comparing the pneumococcal vaccine received: 10 valent (PCV10) versus 13 valent (PCV13). Methods: Descriptive, retrospective study. Hospitalized patients under 5 years of age with a diagnosis of bacterial pneumonia by ICD10 coding in a third level hospital in the city of Quito - Ecuador during 2019 were included. Results: 175 patients were studied, of which 74 patients met clinical criteria for pneumonia, of these 46 received PCV10 and 28 received PCV13 vaccine. Discussion and Conclusions: The prevalence of bacterial pneumonia was higher in patients immunized with PCV10, suggesting a relationship of lower probability of pneumonia with the use of the PCV13 vaccine.
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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.
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@#Objective To screen a kind of solid culture medium without animal-derived materials for resuscitating Streptococcus pneumoniae(Spn).Methods Spn 19F was selected for the preliminary screening of 9 kinds of formula culture media without animal-derived materials,and then other 23 serotypes of Spn were cultured for verification.The effect of the selected medium on the hereditary stability of various serotypes was identified by strain identification and capsular polysaccharide antigen gene sequence analysis of the 15-generation strains.The strains resuscitated by this medium were fermented according to the production procedure,and the culture situation and the yield and quality of capsular polysaccharide antigen were analyzed to determine the production applicability of the screened medium.Results The number of viable bacteria of various types of Spn was desired after 11～15 h of incubation on the selected solid medium and there was no difference in strain identification and antigen gene sequence between the final 15 generation and the control(strains cultured in sheep blood solid medium).After fermentation and culture of the strain resuscitated by this medium,the cell growth and the capsular polysaccharide production increased slightly,and all the related verification indicators of capsular polysaccharide met the requirements in Chinese Pharmacopoeia(Volume Ⅲ,2020 edition).Conclusion The selected solid culture medium without animal-derived materials has good applicability and can replace blood-derived culture medium for the resuscitation of Spn strain for vaccine production.
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@#Abstract: Objective To analyze the clinical characteristics of children with lobar pneumonia and the distribution of pathogens in bronchoalveolar lavage fluid (BALF) collected from these patients, hence providing a scientific basis for their precise diagnosis and treatment. Methods A total of 115 children diagnosed with lobar pneumonia from August 2019 to August 2022 at Suining Central Hospital were screened as the research subjects. The clinical manifestations and occurrence of complications in the patients were investigated. All the children underwent bronchoalveolar lavage after admission, and BALF samples were collected. Fluorescence quantitative PCR was adopted to detect and analyze the distribution and clinical characteristics of Streptococcus pneumoniae (SP) and other related pathogenic microorganisms in BALF specimens. Results Among the 115 pediatric patients with lobar pneumonia, the occurrence of manifestations or complications including involvement of ≥2 lung lobes, myocardial damage, pleural effusion, abnormal liver function, digestive system involvement, nervous system involvement, rash, renal function impairment, and lung atelectasis were observed in 46, 46, 39, 33, 18, 17, 11, 5, and 4 cases, respectively. The pathogen positivity rate in the BALF samples of the 115 patients was 87.0% (100/115), with 81 cases of single infection and 19 cases of mixed infection. A total of 121 strains of pathogens were isolated, including 83 strains of Mycoplasmal pneumonia (MP) (accounting for 68.6%) and SP(13.2%). The differences in the detection rates of HI, MP, RSV strains among different age groups were statistically significant (χ2=8.834, 19.454, 10.284, P<0.05), while the differences in the infection rates of SP, KP, CP, and ADV were not statistically significant (χ2=3.393, 2.67, 0.565, 0.097, P>0.05). The MP pneumonia group showed significantly higher incidence of complications such as pleural effusion, nervous system involvement, and abnormal liver function than the non-MP pneumonia group (χ2=3.925, 4.195, and 4.513, P<0.05). The highest pathogen detection rate was in winter, accounting for 33.91%. Conclusions MP is the most common pathogen in BALF of children with lobar pneumonia. There is variation in the pathogen detection rate among different age groups and seasons. Those with combined infections were more prone to complications, which is worthy of attention by clinicians.
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OBJECTIVE@#To establish and modify quantitative real-time polymerase chain reaction (qPCR)-based serotyping assays to distinguish 97 pneumococcal serotypes.@*METHODS@#A database of capsular polysaccharide ( cps) loci sequences was generated, covering 97 pneumococcal serotypes. Bioinformatics analyses were performed to identify the cps loci structure and target genes related to different pneumococcal serotypes with specific SNPs. A total of 27 novel qPCR serotyping assay primers and probes were established based on qPCR, while 27 recombinant plasmids containing serotype-specific DNA sequence fragments were constructed as reference target sequences to examine the specificity and sensitivity of the qPCR assay. A panel of pneumococcal reference strains was employed to evaluate the capability of pneumococcal serotyping.@*RESULTS@#A total of 97 pneumococcal serotyping assays based on qPCR were established and modified, which included 64 serotypes previously reported as well as an additional 33 serotypes. Twenty-seven novel qPCR serotyping target sequences were implemented in the pneumococcal qPCR serotyping system. A total of 97 pneumococcal serotypes, which included 52 individual serotypes and 45 serotypes belonging to 20 serogroups, could not be identified as individual serotypes. The sensitivity of qPCR assays based on 27 target sequences was 1-100 copies/µL. The specificity of the qPCR assays was 100%, which were tested by a panel of 90 serotypes of the pneumococcal reference strains.@*CONCLUSION@#A total of 27 novel qPCR assays were established and modified to analyze 97 pneumococcal serotypes.
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Reação em Cadeia da Polimerase em Tempo Real , Sorotipagem , Streptococcus pneumoniae/genética , SorogrupoRESUMO
OBJECTIVES@#To investigate the potential relationship between age and Streptococcus pneumoniae vaccination coverage in kindergarten children, and to provide a basis for guiding vaccination and developing new protein vaccines.@*METHODS@#The stratified cluster random sampling method was used to select 1 830 healthy children from six kindergartens in Shunde District, Foshan City, China, and nasopharyngeal swabs were collected for the isolation and identification of Streptococcus pneumoniae. The logistic regression model based on restricted cubic spline was used to analyze the dose-response relationship between age and Streptococcus pneumoniae vaccination coverage.@*RESULTS@#The rate of nasal Streptococcus pneumoniae carriage was 22.46% (411/1 830) among the kindergarten children, with the predominant serotypes of 6B, 19F, 15A, 23A, 34, and 23F. The coverage rates of 10-valent pneumococcal conjugate vaccine (PCV10) and 13-valent pneumococcal conjugate vaccine (PCV13) were 53.0% and 57.9%, respectively, and there was a significant non-linear dose-response relationship between age and the coverage rates of PCV10 and PCV13 (P<0.05), with a higher coverage rate of PCV10 (88.0%) and PCV13 (91.1%) in the children aged 2 years. There was a significant non-linear dose-response relationship between age and the coverage rates of pilus islet 1 (PI-1) and pilus islet 2 (PI-2) (P<0.05), with a lower vaccination coverage rate for PI-1 (37.7%) and PI-2 (16.1%). The coverage rates of PI-1 (13.0%-58.5%) and PI-2 (6.0%-29.4%) were lower in all age groups. The virulence genes lytA (99.5%) and ply (99.0%) associated with candidate protein vaccines showed higher vaccination coverage rates.@*CONCLUSIONS@#There is a significant non-linear dose-response relationship between the age of kindergarten children and the coverage rates of PCV10 and PCV13 serotypes, and kindergarten children aged 2 years have a relatively high coverage rate of PCV. The high prevalence of the virulence genes lytA and ply shows that they are expected to become candidate virulence factors for the development of a new generation of recombinant protein vaccines.
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Humanos , Criança , Lactente , Streptococcus pneumoniae/genética , Infecções Pneumocócicas/epidemiologia , Cobertura Vacinal , Vacinas Pneumocócicas , Sorogrupo , Vacinação , Nasofaringe , Portador Sadio/epidemiologiaRESUMO
ABSTRACT In recent years, the incidence of pediatric septic arthritis caused by Streptococcus pneumoniae has been quite low. The pneumococcal conjugate vaccine PCV10 is the available vaccine included in the Bulgarian national immunization program. PCV10 reduces the incidence of invasive diseases, but non-vaccinal serotypes like 19A, the etiologic agent of the case of septic arthritis reported herein in a 3-year-old boy. The synovial fluid was positive for S. pneumoniae. The patient was treated with vancomycin during hospitalization and trimethoprim/sulfamethoxazole was recommended for at-home treatment. The isolate was subjected to latex agglutination, antimicrobial susceptibility testing, PCR detection for macrolide-resistance genes, and MLST. The strain revealed ST695 and a genotype previously associated with vaccine serotype 4. The incidence of pneumococcal infections caused by capsule-switching events and non-PCV10 serotypes is expected to increase.
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Streptococcus pneumoniae-associated hemolytic uremic syndrome(SP-HUS) is a thrombotic microvascular disease caused by streptococcus pneumoniae infection, which is one of the causes renal failure in children.Clinical manifestations include thrombocytopenia, hemolytic anemia and acute renal failure.The neuraminidase and surface protein C substance of Streptococcus pneumoniae, immune factors and complement play important roles in the pathogenesis of SP-HUS.The complement inhibitors provides a new solution for the treatment of SP-HUS.However, few SP-HUS cases have been reported in China.This paper reviews the pathogenesis, clinical manifestations and treatment of SP-HUS to help clinicians better understand the disease, early recognition and intervention treatment.
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Streptococcus pneumoniae(SP)is one of the common pathogens of respiratory tract infection in children, which can evolve into severe pneumonia and necrotizing pneumonia in case of severe infection.β-lactam antibiotics are the first-line treatment for SP.The resistance mechanism of SP to β-lactam antibiotics is mainly PBPs gene mutation, followed by mutations related to non-PBPs genes such as MurM, CpoA, TEM, CiaH/CiaR-TCSS and StkP-PhpP signal conjugations.Antibiotic selection pressure and vaccine-induced serotype substitution may influence SP resistance.Serotypes 19F and 19A have high resistance to β-lactam antibiotics, and promotion of PCV13 may be more beneficial than other SP vaccines in preventing SP infection in children.
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Introducción: En Paraguay y en otras partes del mundo el Streptococcus pneumoniae es el principal agente causante de neumonía bacteriana, otitis media, meningitis y septicemia. Objetivo: Describir las características clínico-epidemiológicas de pacientes con enfermedad invasiva por Streptococcus pneumoniae atendidos en el Instituto de Medicina Tropical (IMT) durante los años 2016 al 2019. Metodología: Estudio observacional, descriptivo, transversal. Se incluyeron a todos los pacientes con enfermedad invasiva por Streptococcus pneumoniae confirmada. Resultados: Fueron incluidos 34 pacientes, la edad promedio fue de 44años, 76% fueron varones, 61% diagnóstico de infección por VIH. El foco infeccioso predominante fue el pulmonar. De las muestras biológicas con cultivos positivos, el 73% fueron aislados en sangre, y los restantes distribuidos entre muestras de esputo, líquido ceflorraquideo y liquido pleural. El 24% de los pacientes presentaron complicaciones, entre falla orgánica (15%) y empiema (9%). El 59% de los pacientes recibió tratamiento con cefalosporinas. La mortalidad intrahospitalaria registrada fue del 18%.Conclusión: Los pacientes con enfermedad invasiva que acudieron al IMT durante los años 2016 al 2019 fueron en su mayoría adultos jóvenes, inmunosuprimidos, con neumonía.
Introduction: In Paraguay and in other parts of the world, Streptococcus pneumoniae is the main causative agent of bacterial pneumonia, otitis media, meningitis and septicemia. Objective: To describe the clinical-epidemiological characteristics of patients with invasive disease due to Streptococcus pneumoniae treated at the Institute of Tropical Medicine (IMT) during the years 2016 to 2019. Methodology: Observational, descriptive, cross-sectional study. All patients with confirmed invasive disease due to Streptococcus pneumoniae were included. Results: 34 patients were included, the average age was 44 years, 76% were male, 61% diagnosed with HIV infection. The predominant infectious focus was the lung. Of the biological samples with positive cultures, 73% were isolated from blood, and the rest distributed among samples of sputum, cerebrospinal fluid, and pleural fluid. 24% of the patients presented complications, between organic failure (15%) and empyema (9%). 59% of the patients received treatment with cephalosporins. The registered intrahospital mortality was 18%. Conclusion: The patients with invasive disease who attended the IMT during the years 2016 to 2019 were mostly young adults, immunosuppressed, with pneumonia.
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Esta revisión tuvo como propósito explorar la distribución de serotipos y la resistencia antimicrobiana de Streptococcus pneumoniae en la población pediátrica de China a partir de literatura publicada en los últimos seis años. Se realizó una revisión de alcance a partir de PubMed y dos bases de datos de China: CNKI y WanFang Data. Del total de 196 artículos extraídos, se seleccionaron 14 estudios para esta revisión. Hay 13 artículos que analizan la distribución de serotipos de Streptococcus pneumoniae; los serotipos más frecuentemente registrados son: 19F, 19A, 23F, 14 y 6B. Hay 11 artículos que analizan la resistencia antimicrobiana de Streptococcus pneumoniae, la prevalencia de no susceptibles a la penicilina se encuentra en el rango de 0 % a 95,7 %. Los aislados son muy resistentes a eritromicina, clindamicina, tetraciclina y trimetoprima-sulfametoxazol; son resistentes a penicilina en meningitis neumocócica pero son sensibles a penicilina en otras enfermedades neumocócicas, además, son muy sensibles a levofloxacina, vancomicina y Linezolid. Se concluye que la vacuna antineumocócica conjugada 13 tiene alta cobertura en los serotipos de Streptococcus pneumoniae en los niños de China continental, por eso se recomienda su inclusión en el programa de vacunación infantil; al mismo tiempo, se debe tener en cuenta la aparición de la sustitución de serotipos. Por eso, se deben incluir más pacientes pediátricos o niños en las investigaciones, especialmente los menores de cinco años. Es necesaria una vigilancia de alta calidad a largo plazo sobre la distribución de serotipos y resistencia antimicrobiana de Streptococcus pneumoniae para el desarrollo de la prevención de enfermedades neumocócicas.
This review aimed to explore the serotype distribution and antimicrobial resistance of Streptococcus pneumoniae in the Chinese pediatric population based on literature published in the last six years. A scoping review was performed using PubMed and two Chinese databases: CNKI and WanFang Data. Of the total of 196 articles extracted, 14 studies were selected for this review. There are 13 articles that analyze the distribution of Streptococcus pneumoniae serotypes, the most frequently registered serotypes are: 19F, 19A, 23F, 14 and 6B. There are 11 articles that analyze the antimicrobial resistance of Streptococcus pneumoniae, the prevalence of non-susceptible to penicillin is in the range of 0% to 95.7%. Isolates are highly resistant to erythromycin, clindamycin, tetracycline, and trimethoprim-sulfamethoxazole; they are resistant to penicillin in pneumococcal meningitis but are sensitive to penicillin in other pneumococcal diseases, in addition, they are very sensitive to levofloxacin, vancomycin and Linezolid. It is concluded that the pneumococcal conjugate vaccine 13 has high coverage in Streptococcus pneumoniae serotypes in children from mainland China, therefore its inclusion in the childhood vaccination program is recommended; at the same time, the occurrence of serotype substitution should be taken into account. Therefore, more pediatric patients or children should be included in research, especially those under five years of age. Long-term, high-quality surveillance of the serotype distribution and antimicrobial resistance of Streptococcus pneumoniae is necessary for the development of pneumococcal disease prevention.
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El propósito del presente estudio fue describir las características clínicas, serotipos y susceptibilidad antibiótica en pacientes con enfermedad neumocócica invasiva (ENI). Se revisaron las historias clínicas de los pacientes con ENI hospitalizados en el Instituto Nacional de Salud del Niño-Breña (Lima, Perú). Se evaluaron a 29 pacientes. La mediana de edad fue 1,9 años (rango intercuartílico 1 a 4 años). El 51,7% eran mujeres y la forma clínica de la ENI más frecuente fue la bacteriemia en 18 (62,1%) pacientes. El 65,5% tenía el esquema de vacunación completo, según el Ministerio de Salud de Perú. El 82,8% del aislamiento del germen fue de sangre. La resistencia antibiótica fue más frecuente a la eritromicina (55,2%), trimetoprim-sulfametoxazol (48,3%) y penicilina (24,1%). Los serotipos registrados fueron 6C, 19A, 23A y 24F. Un paciente falleció por meningitis. En conclusión, la ENI fue más frecuente en niños de uno a cinco años y en la forma clínica de bacteriemia. Se encontraron cinco serotipos reportados en estudios previos con resistencia a penicilina y eritromicina.
This study aimed to describe the clinical characteristics, serotypes, and antibiotic susceptibility in patients with invasive pneumococcal disease (IPD). The medical records of patients with IPD who were hospitalized at the Instituto Nacional de Salud del Niño-Breña (Lima, Peru) were reviewed. We evaluated 29 patients. The median age was 1.9 years (interquartile range: 1 to 4 years). Of the sample, 51.7% were women and the most frequent clinical form of IPD was bacteremia in 18 (62.1%) patients; 65.5% had a complete vaccination schedule, according to the Peruvian Ministry of Health. Germ isolation was performed from blood samples in 82.8% of patients. Antibiotic resistance to erythromycin (55.2%) was the most frequent, followed by resistance to trimethoprim-sulfamethoxazole (48.3%) and penicillin (24.1%). The isolated serotypes were 6C, 19A, 23A and 24F. One patient died of meningitis. In conclusion, IPD was more frequent in children aged one to five years and the most frequent clinical form was bacteremia. Five serotypes reported in previous studies were found to be resistant to penicillin and erythromycin.
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Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Infecções Pneumocócicas , Streptococcus pneumoniae , Saúde da Criança , Pacientes , Resistência Microbiana a Medicamentos , Vacinas Pneumocócicas , MeningiteRESUMO
Objective: To determine the antimicrobial susceptibility and serotypes of Neisseria (N.) meningitidis and Streptococcus (S.) pneumoniae in Sri Lankan patients. Methods: We retrospectively analyzed 11 blood culture specimens from suspected patients with invasive meningococcal disease and 26 S. pneumoniae clinical isolates. We tested 6 antimicrobials against N. meningitidis and 12 antimicrobials against S. pneumoniae. Meningococcal serogroup was determined by realtime PCR and Quellung serotyping was used for pneumococcal analysis. Results: N. meningitidis serogroup B was the most common in this study. Intermediate-susceptibility to penicillin was seen in 75.0% (6/8) of strains. Susceptibility to ciprofloxacin, levofloxacin and cotrimoxazole was 62.5% (5/8), 62.5% (5/8) and 87.5% (7/8), respectively. Excellent susceptibility was seen in cefotaxime and meropenem. In S. pneumoniae, the most common serotype was 19F in both invasive and non-invasive pneumococcal diseases. The majority of strains showed multidrug resistance. Penicillin non-susceptibility in non-meningeal strains were 13.6% and all meningeal strains were penicillin resistant. Erythromycin was highly resistant in both groups. Amoxicillin showed excellent susceptibility in non-invasive pneumococcal diseases strains. Linezolid, levofloxacin and vancomycin showed 100.0% susceptibility in all pneumococcal isolates. Conclusions: Implementation of vaccines should be considered, especially for children and high-risk populations. This may contribute to reducing pneumococcal and meningococcal invasive disease burden and help prevent emergence of antimicrobial resistant strains.
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Objective:To investigate the clinical characteristics of septic shock caused by an invasive pneumococcal disease (IPD) and analyze the factors that affect the prognosis of this disease.Methods:We retrospectively analyzed the clinical data of 42 children with an IPD-caused septic shock, who received treatment in The Second Hospital of Jiaxing from January 2015 to December 2020, and evaluated the clinical characteristics and prognosis of this disease.Results:The age of the included children averaged 1.3 (0.75, 4.15) years. The Pediatric Index of Mortality 2 was (23.38 ± 9.26) points. Infections were primarily in the blood and brain. Eighteen cases were sensitive to penicillin, 20 cases to cefepime, 22 cases to cefotaxime, and 20 cases to meropenem, vancomycin, and linezolid simultaneously. The mortality was 61.90% (26/42). The Pediatric Index of Mortality 2 [(37.17 ± 10.58) points vs. (0.92 ± 0.39) points, t = 17.45, P < 0.001], and the rate of children developing an intracranial hypertension crisis (69.23% vs. 25.03%) ( χ2 = 7.77, P = 0.05) were significantly higher in the death group than in the survival group. Compared with the survival group, the thoracic infection rate was significantly lower in the death group (7.69% vs. 50.00%, P < 0.05). Conclusion:Most children with an IPD-caused septic shock are young, and most infection sites are in the brain and blood. The IPD-caused septic shock is highly resistant to cephalosporins and penicillin and has high mortality because of an intracranial hypertension crisis. The IPD-caused septic shock should be screened and treated as early as possible.
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Objective:To analyze the binding ability of motifs in the serine/threonine kinase StkP extracellular region (EC-StkP) of Streptococcus pneumoniae to β-lactam antibiotics. Methods:Three motifs (SXXK) in the EC-StkP were mutated into AXXA, respectively or simultaneously. Four mutant plasmids (EC- stkp-AXXA1, EC- stkp-AXXA2, EC- stkp-AXXA3 and EC- stkp-AXXA4) were transfected into recipient cells for cloning and expression. SDS-PAGE combined with gel image analysis was used to detect the expression of the recombinant mutant proteins (EC-rStkP-AXXA1, EC-rStkP-AXXA2, EC-rStkP-AXXA3 and EC-rStkP-AXXA4). The expressed mutated proteins were extracted and purified by Ni-NTA affinity chromatography. The binding abilities of the mutant proteins to penicillin (PCN) and cefotaxime (CTX) were detected by isothermal titration calorimetry (ITC 200) and surface plasmon resonance (Biacore t200). Results:PCN and CTX could not bind to the expressed proteins with mutations in the first or the third motif (EC-rStkP-AXXA1, EC-rStkP-AXXA3, EC-rStkP-AXXA4). EC-rStkP-AXXA2 could weakly bind to CTX, but not to PCN.Conclusions:All three motifs in the EC-StkP of Streptococcus pneumoniae could bind to β-lactam antibiotics with the first and the third motifs being more important.
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Objective:To analyze the clinical characteristics, changes of bacterial resistance and death risk factors of children with streptococcus pneumoniae infection, so as to provide reference for clinical diagnosis and treatment.Methods:From January 2012 to December 2019, hospitalized pediatric patients at Shengjing Hospital of China Medical University were selected.Patients with streptococcus pneumoniae positive in bacterial culture in body fluids of various parts (including alveolar lavage fluid, blood, cerebrospinal fluid, external auditory canal secretions, and local abscess drainage fluid) within one week after admission were selected as subjects.The clinical characteristics and changes of bacterial resistance of 146 children with streptococcus pneumoniae infection were retrospectively analyzed, and 141 children were divided into improved group (124 cases) and death group (17 cases) according to the follow-up results, and the risk factors related to death of streptococcus pneumoniae infection were analyzed.Results:(1)A total of 146 children were included, mainly at age of 1 to 3 years (74 cases, 50.68%), and 14 cases had underlying diseases, including congenital malformation, spinal muscular atrophy, epilepsy and so on.(2) There were 76 (52.05%) cases of invasive streptococcus pneumoniae.There were 106 (72.60%) cases of pulmonary infection, 59 (40.41%) cases of sepsis, 42 (28.77%) cases of purulent meningitis, and five cases of local and pelvic abscess.Five cases were discharge from hospital, 17 cases died, and the rest were all improved.Among the dead children, five cases died because of multiple organ failure, ten cases died because of brain failure and two cases died because of severe sepsis.Six deaths were complicated with septic shock.(3) There were 169 streptococcus pneumoniae positive samples, among them 51 (30.18%) blood samples, 39 (23.08%) cerebrospinal fluid samples, 67 (39.64%) alveolar lavage fluid samples, seven (4.14%) pleural fluid samples, and other body fluid culture samples were five strains.(4) The sensitivity rates of vancomycin, linezolid, moxifloxacin and telithromycin to streptococcus pneumoniae were 100.00%, and that for levofloxacin was 98.82%.The resistant rate of erythromycin to streptococcus pneumoniae was 97.01%, and multidrug resistant rate was 85.61%.(5) Previous convulsions, cerebrospinal fluid or positive blood culture, sepsis, meningitis were risk factors for death(all P<0.05). Children in the death group had shorter out-of-hospital course of disease, lower levels of 24-hour hemoglobin, platelets, serum albumin, and higher levels of C-reactive protein and D-dimer (all P<0.05). Logistics multi-factor analysis showed that, low hemoglobin ( OR=0.31, P=0.025), high D-dimer( OR=1.16, P=0.038), septic shock ( OR=27.81, P=0.008), and positive cerebrospinal fluid culture ( OR=6.34, P=0.034) were independent risk factors for death from streptococcus pneumoniae infection. Conclusion:The average age of streptococcus pneumoniae infection is small, the onset of severe infection is rapid, and the fatality rate as well as and the incidence of invasive pneumococcal disease are high.During clinical treatment, the utilization rate of amoxicillin should be appropriately increased, and the application of cephalosporin antibiotics should be reduced.