Changing serotype distribution and resistance patterns among pediatric nasopharyngeal pneumococci collected in Moscow, 2010-2017.

Serotype distribution and antimicrobial resistance were analyzed in 632 nasopharyngeal pneumococcal isolates collected at a single pediatric center in 2010-2017 before and following the introduction of the 13-valent pneumococcal conjugated vaccine (PCV13) in Russia in 2014. The mean prevalence of PCV13 serotypes was 77.7% in 2010-2015 with a significant decline to 58.5% in 2017, which was accompanied by an elevation in serotype 15B/C prevalence (15.1% in 2017), 66% and 26% of 15B/C-pneumococci related to ST1025 and ST1262, respectively. The rate of oxacillin, erythromycin, and clindamycin resistance has increased by 15-20 percentage points from 2010 to 2016, approaching a 40-45% prevalence in 2016. The resistance rates significantly increased over time only in a group of PCV13 serotypes. The growing resistance among serotype 14 pneumococci was associated with expansion of a multidrug-resistant clone of ST143. These results emphasize the need for close monitoring of the constantly changing pneumococcal population.

Improving the quality of hospital care for children by supportive supervision: a cluster randomized trial, Kyrgyzstan.

OBJECTIVE: To determine whether periodic supportive supervision after a training course improved the quality of paediatric hospital care in Kyrgyzstan, where inappropriate care was common but in-hospital postnatal mortality was low. METHODS: In a cluster, randomized, parallel-group trial, 10 public hospitals were allocated to a 4-day World Health Organization (WHO) course on hospital care for children followed by periodic supportive supervision by paediatricians for 1 year, while 10 hospitals had no intervention. We assessed prospectively 10 key indicators of inappropriate paediatric case management, as indicated by WHO guidelines. The primary indicator was the combination of the three indicators: unnecessary hospitalization, increased iatrogenic risk and unnecessary painful procedures. An independent team evaluated the overall quality of care. FINDINGS: We prospectively reviewed the medical records of 4626 hospitalized children aged 2 to 60 months. In the intervention hospitals, the mean proportion of the primary indicator decreased from 46.9% (95% confidence interval, CI: 24.2 to 68.9) at baseline to 6.8% (95% CI: 1.1 to 12.1) at 1 year, but was unchanged in the control group (45.5%, 95% CI: 25.2 to 67.9, to 64.7%, 95% CI: 43.3 to 86.1). At 1 year, the risk ratio for the primary indicator in the intervention versus the control group was 0.09 (95% CI: 0.06 to 0.13). The proportions of the other nine indicators also decreased in the intervention group (P < 0.0001 for all). Overall quality of care improved significantly in intervention hospitals. CONCLUSION: Periodic supportive supervision for 1 year after a training course improved both adherence to WHO guidelines on hospital care for children and the overall quality of paediatric care.

Detection of respiratory pathogens in pediatric acute otitis media by PCR and comparison of findings in the middle ear and nasopharynx.

We conducted a series of polymerase chain reactions (PCRs) in order to detect bacteria (7 species) and viruses (17 species) in middle ear fluid (MEF) and nasopharynx (Nph) of children with acute otitis media (AOM; n=179). Bacterial and viral nucleic acids were detected in MEF of 78.8% and 14.5% patients, respectively. The prevalence was as follows: Streptococcus pneumoniae, 70.4%; Haemophilus influenzae, 17.9%; Staphylococcus aureus, 16.8%; Streptococcus pyogenes, 12.3%; Moraxella catarrhalis, 9.5%; rhinovirus, 9.5%; and adenovirus, 3.4%. The overall rate of PCR-positive specimens for bacterial pathogens was 2.6 times higher, compared to culture results. The rate of PCR-positive results and the distribution of pathogens in the Nph were similar to those in the MEF. Nph PCR results had variable positive predictive values and high negative predictive values in predicting MEF findings. Our results indicate that Nph PCR could be a practical tool for examining respiratory pathogens in children with acute infections.

Bacterial etiology of acute otitis media and characterization of pneumococcal serotypes and genotypes among children in Moscow, Russia.

BACKGROUND: We aimed to describe bacterial etiology of acute otitis media (AOM) and characterize resistance, serotypes and genotype profiles of AOM-causing pneumococci recovered in Moscow children. METHODS: Children with AOM and an available middle ear fluid specimen were prospectively enrolled in this study. Streptococcus pneumoniae, Streptococcus pyogenes, Haemophilus influenzae and Moraxella catarrhalis were considered as true otopathogens. All pneumococcal isolates were serotyped using the Quellung reaction; multidrug-resistant (MDR) pneumococci underwent multilocus sequence typing. RESULTS: In 172 of 541 enrolled AOM patients (32%) at least 1 otopathogen was recovered, with S. pneumoniae having the highest rate of 63% (109/172). When adjusted for antibiotic treatment before sampling, in untreated patients the rate of culture-positive AOM was 35% (124/352), S. pneumoniae had a prevalence of 69% (86/124), S. pyogenes 19% (24/124), H. influenzae 13% (16/124) and M. catarrhalis 9% (11/124). Among 107 examined pneumococci, 45% were penicillin-nonsusceptible, 34 and 30% were resistant to erythromycin and clindamycin, respectively; 30% had an MDR phenotype, but no amoxicillin-resistant isolates were found. Ten of 32 (31%) MDR pneumococci related to clonal complex 320, the remaining isolates belonged to 7 different clonal complex. Six leading serotypes were 19F (27%), 3 (12%), 6B (11%), 14 (11%), 19A (9%) and 23F (8%); overall polysaccharide conjugate vaccine13 coverage was 93%. CONCLUSIONS: S. pneumoniae, the leading bacterial AOM pathogen in Moscow children, is characterized by a substantial rate of antibiotic nonsusceptibility and clonality. A polysaccharide conjugate vaccine with expanded coverage seems to fit the current AOM pneumococcal serotype distribution in Russia better.

Serotypes and antibiotic resistance of non-invasive Streptococcus pneumoniae circulating in pediatric hospitals in Moscow, Russia.

BACKGROUND: Pneumococcal infections remain a major medical problem associated with high morbidity and mortality. Moreover, the resistance of Streptococcus pneumoniae to conventional antibiotics is constantly growing. The implementation of pneumococcal conjugate vaccines (PCVs) in the last decade has dramatically reduced the incidence of the vaccine type-associated invasive pneumococcal diseases in many countries. However, information on the seroepidemiology of S. pneumoniae in Russia is limited. METHODS: We report the results of serotyping and antibiotic susceptibility testing performed on 863 non-invasive pneumococcal isolates collected prospectively in 2009-2013 from children (median age 3.5 years) who sought medical care at five pediatric hospitals in Moscow. The isolates were recovered from the nasopharynx (71.2%), middle ear fluid (14.3%), and lower respiratory tract specimens (13.6%). RESULTS: In total, we identified 45 different serotypes. The six leading serotypes (prevalence >5%) included 19F (21.7%), 6B (12.8%), 23F (10.1%), 14 (9.0%), 6A (8.4%), and 3 (7.5%). Serotype 19A isolates had a prevalence of 2.3%. The proportion of PCV-13 serotypes was 78%; the coverage by PCV-7 was 58.2% and was similar to that of PCV-10 (59.8%). The rate of multidrug-resistant pneumococci (i.e., resistant to ≥3 antimicrobials) was 22%. The majority of the multidrug-resistant isolates were serotype 6B, 14, 19A, and 19F. Penicillin non-susceptibility was displayed by 28% of the isolates. The resistance rate to erythromycin was 26%. Among the examined erythromycin-resistant strains, 54% had the erm(B) gene and 13% had the mef gene as a single resistance determinant, whereas both determinants were found in 31% of these strains. CONCLUSIONS: Our data predict a good coverage of the circulating S. pneumoniae by the PCVs and could be useful for evaluating the serotype distribution in support of the introduction of PCV in Russia. In addition, the antimicrobial resistance rate of S. pneumoniae in Russia is substantial, and the emergence of pneumococcal strains with a dual macrolide resistance mechanism is alarming.

Streptococcus pneumoniae serotype distribution in children in the Russian Federation before the introduction of pneumococcal conjugate vaccines into the National Immunization Program.

WHO recommends the inclusion of PCVs in childhood vaccination programs world-wide. Many countries including the Russian Federation are currently planning the inclusion of PCVs in their National Immunization Programs and, therefore, data on the pneumococcal serotype distribution is important to estimate the potential disease impact. Here we review eight recent epidemiological studies on the pneumococcal serotype distribution from Russia. Across all studies, serotypes 6B, 14, 19F and 23F were the most prevalent. Interestingly, serotype 3 was relatively common. Serotype 19A was prevalent among AOM, CAP and nasopharyngeal isolates and among antibiotic resistant isolates in all age groups. The differences in serotype coverage between PCV10 and PCV13 were up to 26%. Based on the current data on serotype distribution, a wide use of PCVs in Russia may lead to a significant reduction of the pneumococcal disease burden.