Epidemiología de la neumonía neumocócica en adultos mayores de 50 años: estudio de cohortes en Cataluña, 2017-2018 / Epidemiology of pneumococcal pneumonia among middle-aged and older adults in Catalonia, 2017–2018

Objetivo: Analizar la incidencia y letalidad de la neumonía neumocócica (NN) en adultos tras la implementación de la vacunación universal en los niños. Diseño: Estudio de cohortes de base poblacional. Emplazamiento: Atención primaria/hospital, Cataluña. Participantes: 2.059.645 personas≥50 años afiliadas al Institut Català de la Salut, con seguimiento retrospectivo entre 01/01/2017-31/12/2018. Mediciones principales: El Sistema de Información para el Desarrollo de la Investigación en Atención Primaria (SIDIAP) de Cataluña fue usado para establecer las características basales de los miembros de la cohorte, clasificados en 3 estratos de riesgo: bajo (inmunocompetentes sin condiciones de riesgo), medio (inmunocompetentes con alguna condición de riesgo) y alto (inmunocompromiso/asplenia). La ocurrencia de NN entre los miembros de la cohorte fue identificada mediante Conjunto Mínimo Básico de Datos de los 64 hospitales catalanes de referencia. Resultados: Se registraron 3592 episodios de NN, con una incidencia de 90,7 casos por 100.000 personas-año (IC 95%: 85,2-96,5), siendo 11,9 bacteriémicas (IC 95%: 10,8-13,1) y 78,8 no bacteriémicas (IC 95%: 74,0-83,8). La incidencia aumentó sustancialmente según edad (37,3 en 50-64; 98,3 en 65-79 y 259,8 en ≥80 años) y estrato de riesgo basal (42,1; 120,7 y 238,6 en bajo, medio y alto riesgo, respectivamente). La letalidad global fue del 7,6% (10,8% en casos invasivos vs. 7,1%en no invasivos; p=0,004). En modelos multivariantes, estrato de riesgo alto y edad avanzada (>80 años) fueron los más fuertes predictores para padecer episodios invasivos y no invasivos, respectivamente. Conclusión: La incidencia y letalidad de la NN fue moderada en la población>50 años de Cataluña durante 2017-2018.(AU)

Objective: To analyse population-based incidence and lethality of pneumococcal pneumonia (PP) requiring hospitalisation among Catalonian adults after universal vaccination implementation in infants. Design: Population-based cohort study. Setting: Primary care/hospital, Catalonia. Participants: 2,059,645 individuals ≥50 years old affiliated to the Institut Catala de la Salut retrospectively followed between 01/01/2017 and 31/12/2018. Main outcome measures: The Catalonian information system for the development of research in primary care (SIDIAP, Sistema de Información para el Desarrollo de la Investigación en Atención Primaria) was used to establish baseline characteristics and risk-strata of cohort members at study start: low-risk (immunocompetent persons without risk conditions), intermediate-risk (immunocompetent persons with at-risk condition) and high-risk (immunocompromising conditions). PP requiring hospitalisation among cohort members across study period were collected from CMBD (Conjunto Mínimo Básico de Datos) discharge data of 64 reference Catalonian hospitals. Results: An amount of 3592 episodes of HPP were observed, with an incidence density of 90.7 cases per 100,000 person-years (95% CI: 85.2-96.5), being 11.9 bacteremic (95% CI: 10.8-13.1) and 78.8 non-bacteremic (95% CI: 74.0-83.8). Incidence rates substantially increased by age (37.3 in 50-64 years vs. 98.3 in 65-79 years vs. 259.8 in ≥80 years) and baseline-risk stratum (42.1, 120.7 and 238.6 in low-, intermediate- and high-risk stratum, respectively). Overall case-fatality rate was 7.6% (10.8% in invasive cases vs. 7.1% in non-invasive cases; pP=.004). In multivariable analyses, high-risk stratum and oldest age were the strongest predictors for invasive and non-invasive cases, respectively. Conclusion: Incidence and lethality of PP remained moderate among adults >50 years in Catalonia during 2017–2018 (earlier period after universal vaccination introduction for infants).(AU)

[Epidemiology of pneumococcal pneumonia among middle-aged and older adults in Catalonia, 2017-2018]. / Epidemiología de la neumonía neumocócica en adultos mayores de 50 años: estudio de cohortes en Cataluña, 2017-2018.

OBJECTIVE: To analyse population-based incidence and lethality of pneumococcal pneumonia (PP) requiring hospitalisation among Catalonian adults after universal vaccination implementation in infants. DESIGN: Population-based cohort study. SETTING: Primary care/hospital, Catalonia. PARTICIPANTS: 2,059,645 individuals ≥50 years old affiliated to the Institut Catala de la Salut retrospectively followed between 01/01/2017 and 31/12/2018. MAIN OUTCOME MEASURES: The Catalonian information system for the development of research in primary care (SIDIAP, Sistema de Información para el Desarrollo de la Investigación en Atención Primaria) was used to establish baseline characteristics and risk-strata of cohort members at study start: low-risk (immunocompetent persons without risk conditions), intermediate-risk (immunocompetent persons with at-risk condition) and high-risk (immunocompromising conditions). PP requiring hospitalisation among cohort members across study period were collected from CMBD (Conjunto Mínimo Básico de Datos) discharge data of 64 reference Catalonian hospitals. RESULTS: An amount of 3592 episodes of HPP were observed, with an incidence density of 90.7 cases per 100,000 person-years (95% CI: 85.2-96.5), being 11.9 bacteremic (95% CI: 10.8-13.1) and 78.8 non-bacteremic (95% CI: 74.0-83.8). Incidence rates substantially increased by age (37.3 in 50-64 years vs. 98.3 in 65-79 years vs. 259.8 in ≥80 years) and baseline-risk stratum (42.1, 120.7 and 238.6 in low-, intermediate- and high-risk stratum, respectively). Overall case-fatality rate was 7.6% (10.8% in invasive cases vs. 7.1% in non-invasive cases; pP=.004). In multivariable analyses, high-risk stratum and oldest age were the strongest predictors for invasive and non-invasive cases, respectively. CONCLUSION: Incidence and lethality of PP remained moderate among adults >50 years in Catalonia during 2017-2018 (earlier period after universal vaccination introduction for infants).

Enfermedad invasiva por Streptococcus pneumoniae, en pacientes adultos. Periodo 2016 al 2018

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.

Necrotizing pneumonia due to Streptococcus pneumoniae in children during the period of non-systematic use of PCV13 in Catalonia, Spain.

BACKGROUND: Some studies have observed an increased incidence of necrotizing pneumonia (NP) in recent years. This might be related to the emergence of non-vaccine S. pneumoniae serotypes after PCV7 introduction although it is suggested that evolutionary factors may have modified the virulence and the interactions of pneumococci. The aim of this study was to clinically and microbiologically define NP in the population served by the three major paediatric hospitals in Barcelona (Catalonia, Spain). METHODS: A prospective observational study was conducted in patients <18 years hospitalized due to invasive pneumococcal disease (January 2012-June 2016). Data of confirmed cases of pneumococcal NP (diagnosed by culture or DNA detection and serotyped) were collected. PCV13 was not systematically administered in Catalonia during the study period, but was available in the private market so the vaccination coverage in children increased from 48.2% to 74.5%. RESULTS: 35 cases of NP were identified. 77.1% of cases were associated with empyema. In the first 4 years, a trend to a decrease in NP incidence was observed (p=0.021), especially in children <5 years (p=0.006). Serotype 3 was responsible for 48.6% of NP cases. Five patients with NP due to serotype 3 were fully vaccinated for their age with PCV13. CONCLUSIONS: Serotype 3 has a preeminent role in pneumococcal NP and was associated with all PCV13 vaccination failures. Although in our series the incidence does not seem to be increasing, evolution of pneumococcal NP rates should be monitored after inclusion of PCV13 in the systematic calendar.

Necrotizing pneumonia due to Streptococcus pneumoniae in children during the period of non-systematic use of PCV13 in Catalonia, Spain / Neumonía necrosante por Streptococcus pneumoniae en niños durante el periodo de uso no sistemático de la PCV13 en Cataluña, España

Background: Some studies have observed an increased incidence of necrotizing pneumonia (NP) in recent years. This might be related to the emergence of non-vaccine S. pneumoniae serotypes after PCV7 introduction although it is suggested that evolutionary factors may have modified the virulence and the interactions of pneumococci. The aim of this study was to clinically and microbiologically define NP in the population served by the three major paediatric hospitals in Barcelona (Catalonia, Spain). Methods: A prospective observational study was conducted in patients <18 years hospitalized due to invasive pneumococcal disease (January 2012–June 2016). Data of confirmed cases of pneumococcal NP (diagnosed by culture or DNA detection and serotyped) were collected. PCV13 was not systematically administered in Catalonia during the study period, but was available in the private market so the vaccination coverage in children increased from 48.2% to 74.5%. Results: 35 cases of NP were identified. 77.1% of cases were associated with empyema. In the first 4 years, a trend to a decrease in NP incidence was observed (p=0.021), especially in children <5 years (p=0.006). Serotype 3 was responsible for 48.6% of NP cases. Five patients with NP due to serotype 3 were fully vaccinated for their age with PCV13. Conclusions: Serotype 3 has a preeminent role in pneumococcal NP and was associated with all PCV13 vaccination failures. Although in our series the incidence does not seem to be increasing, evolution of pneumococcal NP rates should be monitored after inclusion of PCV13 in the systematic calendar.(AU)

Antecedentes: En algunos estudios se ha observado un aumento de la incidencia de neumonía necrosante (NN) en los últimos años. Dicho aumento podría estar asociado a la aparición de serotipos de S. pneumoniae no vacunales después de la introducción de la PCV7, aunque se sugiere que factores evolutivos podrían haber modificado la virulencia y las interacciones de los neumococos. El objetivo de este estudio fue definir clínica y microbiológicamente la NN en la población tratada en los 3 hospitales pediátricos principales de Barcelona (Cataluña, España). Métodos: Se llevó a cabo un estudio observacional prospectivo en pacientes <18 años hospitalizados a causa de una enfermedad neumocócica invasiva (enero de 2012-junio de 2016). Se recopilaron datos de casos confirmados de NN neumocócica (diagnosticada mediante cultivo o detección de ADN y serotipado). La PCV13 no se administró de forma sistemática en Cataluña durante el periodo del estudio, pero se encontraba disponible en el mercado privado, por lo que la cobertura de vacunación en niños pasó del 48,2 al 74,5%. Resultados: Se identificaron 35 casos de NN. El 77,1% de los casos estuvieron asociados a un empiema. En los primeros 4 años se observó una tendencia decreciente de la incidencia de NN (p=0,021), especialmente en niños <5 años (p=0,006). El serotipo 3 causó el 48,6% de los casos. Cinco pacientes con NN debida al serotipo 3 estaban completamente vacunados para su edad con la PCV13. Conclusiones: El serotipo 3 desempeña un papel prominente en la NN neumocócica y se asoció a todos los fracasos de vacunación de la PCV13. Aunque en nuestra serie la incidencia no parece estar aumentando, debe controlarse la evolución de las tasas de NN neumocócica tras la inclusión de la PCV13 en el calendario sistemático.(AU)

Protocolo clínico de diagnóstico y tratamiento de pacientes con neumonía adquirida en la comunidad que ingresan a la Unidad de Cuidados Intensivos / Clinical protocol for diagnosis and treatment of patients with community-acquired pneumonia admitted to the Intensive Care Unit

La neumonía es una infección frecuente que se presenta en todas las edades, en cualquier tipo de pacientes y a nivel co-munitario u hospitalario. La neumonía que se origina en la comunidad afecta a los pacientes con comorbilidades y en los extremos de la vida. La mortalidad de la neumonía comunitaria (NC) per-manece elevada, los sistemas de salud deben implementar estrategias para diagnosticar y tratar de forma rápida a estos pacientes. Cuando un paciente con neumonía comunitaria es ingresado en la emergencia de cualquier hospital se debe categorizar su estado para que reciba el mejor tratamiento posible. La Unidad de Cuidados Intensivos (UCI) participa en la detección de los pacientes con neu-monía adquirida en la comunidad grave, con el objetivo de priorizar su atención para lograr las metas de manejo lo más rápido posible y disminuir la mortalidad de estos pacientes.

Pneumonia is a common infection that occurs in all ages, in any type of patient and at the community or hospital level. Community-originating pneumonia affects patients with comorbidities and at the ex-tremes of life. Mortality from commu-nity pneumonia remains high, health sys-tems must implement strategies to quickly diagnose and treat these patients. When a patient with community pneumonia is admitted to any hospital emergency, their condition must be categorized so that they receive the best possible treat-ment. The Intensive Care Unit (ICU) participates in the detection of patients with severe community-acquired pneu-monia, with the objective of prioritizing their care to achieve management goals as quickly as possible and reduce the mortality of these patients.

Neumonía adquirida en la comunidad en pacientes que requirieron hospitalización / Community acquired pneumonia in patients requiring hospitalization

Resumen La neumonía adquirida en la comunidad (NAC) representa un importante problema sanitario y ~20% de los pacientes requiere hospitalización. El objetivo principal del trabajo fue determinar las características clínico-imagenológicas de los episodios de NAC que requirieron internación. Los objetivos secundarios fueron determinar el rédito diagnóstico de los estudios microbiológicos e identificar las complicaciones. Realizamos un estudio analítico retrospectivo en un hospital de tercer nivel durante el período 2017-2019, en adultos admitidos por NAC, excluyendo embarazadas. Identificamos 340 episodios en 321 pacientes, la mediana de edad fue 75 años (rango intercuartil 57-85). Los factores de riesgo más frecuentes fueron inmunocompromiso (30%), enfermedad neurológica (22%) y enfermedad renal crónica (17%). Según tres scores pronósticos de gravedad, CURB65, qSOFA y PSI/PORT, 216 (63.5%), 290 (85.3%) y 130 (38%) episodios fueron identificados como de bajo riesgo, respectivamente. Del total de los episodios, 49 (14.4%) requirieron internación en unidad de cuidados intensivos, 39 (11.5%) ventilación mecánica y se registraron 30 (8.8%) muertes durante la hospitalización. Los patrones de imagen más frecuentes fueron consolidativo en 134 (39.4%), intersticio-alveolar en 98 (28.8%) y mixto entre ambos patrones en 67 (19.7%) episodios. Identificamos el agente causal en 79 (23.2%) episodios. Los microorganismos aislados más frecuentemente fueron influenza en 37 (10.9%) y Streptococcus pneumoniae en 11 (3.2%). La mayoría de los episodios afectaron pacientes ancianos y el principal patrón radiológico fue el consolidativo. El agente causal se pudo identificar en uno de cada cuatro episodios y el método con mayor rédito diagnóstico fue el test para influenza.

Abstract Community-acquired pneumonia (CAP) represents a major health issue and ~20% of the patients require in-hospital attention. The main objective of the study was to determine clinical-imaging features of CAP episodes requiring hospitalization. The secondary objectives were to determine the diagnostic yield of microbiological analyses and the medical complications. A retrospective analytical study was conducted on adults admitted due to CAP in a third-level hospital in the period 2017-2019. Pregnant women were excluded. A total of 340 CAP episodes were identified in 321 patients; the median age was 75 years old (interquartile range 57-85). The most frequent risk factors were immunocompromise 102 (30%), neurological disease 75 (22%), and chronic kidney disease 58 (17%). According to three prognostic scores, CURB65, qSOFA and PSI/PORT, 216 (63.5%), 290 (83.5%) and 130 (38%) patients were identified as low risk, respectively. A total of 49 (14.4%) episodes required admission at the critical care unit and 39 (11.5%) required mechanical ventilation; 30 patients (8.8%) died during hospitalization. The radiologic patterns most frequently found were consolidation in 134 (39.4%), interstitial-alveolar pattern in 98 (28.8%), and the combination of both patterns in 67 (19.7%) episodes. Identification of the causal agent was achieved in 79 (23.2%) episodes. The most frequently isolated microorganisms were influenza virus in 37 (10.9%) episodes and Streptococcus pneumoniae in 11 (3.2%). Most of the hospitalized CAP patients were elderly with consolidative radiological patterns. The causal agent could be identified in less than a quarter of the patients, with the influenza test being the method with the highest diagnostic yield.

Necrotizing pneumonia due to Streptococcus pneumoniae in children during the period of non-systematic use of PCV13 in Catalonia, Spain.

BACKGROUND: Some studies have observed an increased incidence of necrotizing pneumonia (NP) in recent years. This might be related to the emergence of non-vaccine S. pneumoniae serotypes after PCV7 introduction although it is suggested that evolutionary factors may have modified the virulence and the interactions of pneumococci. The aim of this study was to clinically and microbiologically define NP in the population served by the three major paediatric hospitals in Barcelona (Catalonia, Spain). METHODS: A prospective observational study was conducted in patients <18 years hospitalized due to invasive pneumococcal disease (January 2012-June 2016). Data of confirmed cases of pneumococcal NP (diagnosed by culture or DNA detection and serotyped) were collected. PCV13 was not systematically administered in Catalonia during the study period, but was available in the private market so the vaccination coverage in children increased from 48.2% to 74.5%. RESULTS: 35 cases of NP were identified. 77.1% of cases were associated with empyema. In the first 4 years, a trend to a decrease in NP incidence was observed (p=0.021), especially in children <5 years (p=0.006). Serotype 3 was responsible for 48.6% of NP cases. Five patients with NP due to serotype 3 were fully vaccinated for their age with PCV13. CONCLUSIONS: Serotype 3 has a preeminent role in pneumococcal NP and was associated with all PCV13 vaccination failures. Although in our series the incidence does not seem to be increasing, evolution of pneumococcal NP rates should be monitored after inclusion of PCV13 in the systematic calendar.

Neumonía necrotizante en niños: 10 años de experiencia en un hospital pediátrico de referencia / Necrotizing pneumonia in children: 10 years of experience in a Pediatric Reference Hospital / Pneumonia necrosante em crianças: 10 anos de experiência em um Hospital Pediátrico de Referência

Resumen: Introducción: neumonía necrotizante (NN) es una complicación frecuente en niños hospitalizados por neumonía adquirida en la comunidad (NAC), caracterizada por importante morbilidad. En 2009, se elaboró una definición de caso, que permitió unificar criterios y racionalizar recursos en la asistencia de estos niños. Objetivo: describir características clínicas y evolutivas de niños que desarrollaron NN en los últimos 10 años. Metodología: estudio descriptivo de niños hospitalizados por NN entre 1/1/2009 y 31/12/2018. Definición de caso: neumatoceles y uno o más de los siguientes criterios: mal estado general, fiebre persistente o recurrente, leucocitosis mayor a 30.000 o menor a 5.000/mm3, proteína C reactiva mayor a 120 mg/dl, láctico deshidrogenasa en líquido pleural mayor a 2.500 UI/L y/o fístula broncopleural (FBP). Se describieron características epidemiológicas, clínicas, etiológicas y evolutivas. Resultados: se diagnosticó NN en 197 niños (7,92% de las hospitalizaciones por NAC), con número anual de casos y tasas/10.000 egresos variables. La mediana de edad fue de 25 meses; 89,8% eran sanos. La fiebre previa al diagnóstico tuvo mediana de cinco días. Tenían neumonía multilobar 58%, insuficiencia respiratoria 62%, sepsis 19%, empiema 80% y fístula bronquio-pleural 51%. Persistieron con fiebre mediana por siete días. Requirieron cuidados intensivos 46% y asistencia ventilatoria mecánica 18%. Los reactantes de fase aguda al ingreso fueron elevados. Se identificó agente etiológico en 102 casos, S. pneumoniae en 92. Fallecieron dos niños. Conclusiones: NN fue una complicación frecuente en niños hospitalizados por NAC. La presentación clínica y la evolución fueron graves. La identificación etiológica fue elevada, la mayoría correspondió a S. pneumoniae. La mortalidad fue baja.

Summary: Introduction: necrotizing pneumonia (NP) is a complication of community-acquired pneumonia (CAP) in hospitalized children, with significantly high morbidity. A case definition was devised in 2009, which enabled physicians to unify criteria and rationalize resources for the assistance of children with NP. Objective: describe clinical characteristics and evolution of children who developed NP. Methodology: descriptive study, NP hospitalized children between 1/1/2009 and 12/31/2018. Case definition: pneumatoceles and one or more of the following criteria: malaise, persistent/recurrent fever, white blood cell count over 30,000 or less than 5.000/mm3, C-reactive protein over 120 mg/dL, lactic dehydrogenase in pleural fluid over 2,500UI/L and/or bronchopleural fistula (BPF). Clinical, epidemiological, etiological and evolutionary characteristics were described. Results: NP was diagnosed in 197 children (7.92% of CAP hospitalizations), with variable annual cases and annual rate/10,000 discharges. Children had a median age of 25 months; 89.8% were previously healthy. They presented fever prior to diagnosis, median 5 days, multilobar pneumonia 58%, respiratory failure 62%, sepsis 19%, empyema 80% and BPF 51%, persistent fever median 7 days. 46% required intensive care and 18% required assisted mechanical ventilation. Acute phase reactants on admission were high. An etiological agent was identified in 102 cases, S.pneumoniae in 92. Two children died. Conclusions: NP was a frequent complication in CAP hospitalized children. Clinical presentation and evolution were severe. The etiological identification was high, most of them corresponded to S. pnuemoniae. Mortality was low.

Resumo: Introdução: a pneumonia necrosante (PN) é uma complicação da pneumonia adquirida na comunidade (PAC) em crianças hospitalizadas, com morbidade significativamente elevada. Em 2009, elaborou-se uma definição de caso, que possibilitou aos médicos unificar critérios e racionalizar recursos para o atendimento à criança com PN. Objetivo: descrever as características clínicas e evolutivas de crianças que desenvolveram PN nos últimos 10 anos. Metodologia: estudo descritivo de crianças internadas por PN entre 01/01/2009 e 31/12/2018. Definição de caso: pneumatoceles e um ou mais dos seguintes critérios: mau estado geral, febre persistente ou recorrente, leucocitose superior a 30.000 ou inferior a 5.000 / mm3, proteína C reativa superior a 120 mg / dl, desidrogenase láctica no líquido pleural superior 2.500 UI / L e / ou fístula broncopleural (BPF). Descreveram-se características epidemiológicas, clínicas, etiológicas e evolutivas. Resultados: a PN foi diagnosticada em 197 crianças (7,92% das internações por PAC), com número de casos e taxas anuais variáveis/10.000 altas. A idade média foi de 25 meses; 89,8% eram saudáveis. A febre antes do diagnóstico teve uma mediana de 5 dias. Eles tinham 58% de pneumonia multilobar, 62% de insuficiência respiratória, 19% de sepse, 80% de empiema e 51% de FBP. Eles persistiram com febre mediana por 7 dias. 46% necessitaram de cuidados intensivos e 18% de assistência ventilatória mecânica. Os reagentes de fase aguda na admissão foram elevados. Em 102 casos foi identificado um agente etiológico, S. pneumoniae em 92. 2 crianças morreram. Conclusões: NP é uma complicação frequente em crianças hospitalizadas por PAC. O quadro clínico e a evolução foram graves. A identificação etiológica foi alta, a maioria correspondeu a S. pneumoniae. A mortalidade foi baixa.

[Risk of pneumococcal disease in elderly patients with and without previous vaccination]. / Riesgo de enfermedad neumocócica en pacientes ancianos con y sin vacunación previa.

OBJECTIVES: To know the pneumococcal vaccination coverage in patients≥65 years old, as well as the risk of pneumococcal disease according to whether or not they received such vaccination. DESIGN: Cross-sectional study, followed by historical cohort. LOCATION: Urban area. PARTICIPANTS: By systematic sampling, 2,805 people≥65 years from the city of Albacete were selected. MAIN MEASUREMENTS: Dependent variable: diagnosis of pneumococcal disease and date. INDEPENDENT VARIABLES: age, sex, chronic pathologies, medication, pneumococcal vaccination and date. The computerized medical records were reviewed, from 1-1-2009 to October-December 2015. A descriptive analysis was carried out, the relative risk of the onset of pneumococcal disease according to vaccination has been calculated, and survival analysis has been carried out, with the statistical program SPSS 17.0. RESULTS: Median age 71 years; 57.2% were women; 46% received polysaccharide vaccine (95% CI 44.1-47.8). Only 10 people received conjugated vaccine. Twenty-two people were diagnosed with invasive pneumococcal disease and 153 non-invasive. The relative risk of pneumococcal disease in vaccinated versus unvaccinated, respectively for invasive and non-invasive, was 1.59 (95% CI 0.69-3.68) and 1.84 (95% CI 1.33-2.54). Cox regression showed a higher risk of non-invasive disease for COPD (1.95; 95% CI 1.32-2.89), smoking (1.87; 95% CI 1.28-2.73), corticoid-therapy (1.73; 95% CI 1.08-2.79), polysaccharide vaccination (141.41; 95% CI 5.92-3,378.49) and age (1.11; 95% CI 1.08-1.14), with interaction between these 2 (0.94, 95% CI 0.91-0.98). CONCLUSIONS: There is an increased risk of pneumococcal disease in patients≥65 years vaccinated with polysaccharide, although with a protective effect in vaccinated older.

Community acquired pneumonia incidence among children less than 5 years of age in Concordia, Argentina: vaccination impact / Incidencia de la neumonía extrahospitalaria en menores de 5 años en Concordia (Argentina): repercusión de la vacunación / Incidência de pneumonia adquirida na comunidade em crianças menores de 5 anos em Concordia, Argentina: impacto da vacinação

ABSTRACT Objective To measure the effectiveness of pneumococcal conjugated vaccine (PCV13) against Community Acquired Pneumonia (CAP) and invasive pneumococcal disease, 2 years after the vaccine (2+1) was included into the National Immunization Program of Argentina, and to describe variables associated with bacterial pneumonia and hospitalization. Methods This was a prospective, population-based surveillance study of CAP incidence (ambulatory and hospitalized) among children less than 5 years of age in the Department of Concordia (Entre Rios, Argentina) from April 2014 - March 2016. The diagnosis of probable bacterial pneumonia (PBP) was determined following the standardized WHO protocol. Incidence during the post-vaccine introduction period was compared with the results from a previous study that used similar methodology for the pre-PCV13 introduction period from 2002 - 2005. Results During the study period, 330 patients had a clinical diagnosis of CAP, of which 92 were PBP (6 with pleural effusion). S. pneumoniae was not isolated from any sample. No factors associated with PBP were found in multivariable analysis. The decrease in PBP and pleural effusion was significant in relation to the previous study: 63% (P < 0.0001) and 80.9% (P < 0.003), respectively. PCV13 uptake was 97.3% for the 1st dose and 84.8% for the booster dose. Conclusions PCV13 was effective to reduce incidence of consolidated pneumonia and pleural effusion, among children less than 5 years of age in Concordia, Argentina. Vaccination is a very effective public health strategy for reducing vaccine preventable diseases, with impact on burden of disease and hospitalization.

RESUMEN Objetivo Medir la efectividad de la vacuna antineumocócica conjugada (VNC13)contra la neumonía extrahospitalaria y las enfermedades neumocócicas invasoras, dos años después de que se incorporara la vacuna (2+1) en el Programa Nacional de Vacunación de Argentina, y describir las variables asociadas con la neumonía bacteriana y la hospitalización. Métodos Se llevó a cabo un estudio prospectivo de vigilancia poblacional de la incidencia de la neumonía extrahospitalaria (pacientes ambulatorios y hospitalizados) en menores de 5 años en el departamento Concordia (Entre Ríos, Argentina) desde abril del 2014 hasta marzo del 2016. Se determinó el diagnóstico de probable neumonía bacteriana según el protocolo estandarizado de la OMS. Se comparó la incidencia durante el período posterior a la incorporación de la vacuna con los resultados de un estudio anterior en el que se usó una metodología similar para el período previo a la incorporación de la VNC13 entre el 2002 y el 2005. Resultados Durante el estudio, 330 pacientes presentaron un diagnóstico clínico de neumonía extrahospitalaria, de los cuales 92 presentaron probable neumonía bacteriana (6 con derrame pleural). No se aisló ninguna muestra del S. pneumoniae. No se encontraron factores asociados con la neumonía bacteriana probable en el análisis multivariante. La disminución de la neumonía bacteriana probable y el derrame pleural fue significativa en relación con el estudio anterior: 63 % (P < 0,0001) y 80,9 % (P < 0,003), respectivamente. La absorción de la VNC13 fue de 97,3 % para la primera dosis y de 84,8 % para la dosis de refuerzo. Conclusiones La VNC13 fue efectiva para reducir la incidencia consolidada de derrame pleural y neumonía en menores de 5 años en Concordia (Argentina). La vacunación es una estrategia de salud pública muy efectiva para reducir las enfermedades prevenibles por vacunación, con repercusión en la carga de enfermedad y la hospitalización.

RESUMO Objetivo Avaliar a efetividade da vacina pneumocócica conjugada (PCV13) em prevenir pneumonia adquirida na comunidade (PAC) e doença pneumocócica invasiva (DPI) após 2 anos da incorporação da vacina (2 + 1) ao Programa Nacional de Vacinação da Argentina e descrever as variáveis associadas à ocorrência de pneumonia bacteriana e internação hospitalar. Métodos Estudo prospectivo de base populacional de vigilância da incidência de PAC (atendimento ambulatorial e em internação hospitalar) em crianças menores de 5 anos de idade realizado no Departamento de Concordia, Entre Rios, na Argentina, de abril de 2014 a março de 2016. O diagnóstico de provável pneumonia bacteriana foi determinado segundo o protocolo padronizado da OMS. A incidência no período pós-introdução da vacina foi comparada aos resultados de um estudo anterior realizado com metodologia semelhante no período pré-introdução da PCV13 de 2002 a 2005. Resultados No período de estudo, foi feito o diagnóstico clínico de PAC em 330 pacientes, dos quais 92 foram casos de provável pneumonia bacteriana (6 com derrame pleural). A bactéria Streptococcus pneumoniae não foi isolada em nenhuma amostra. Não foi observado nenhum fator associado à provável pneumonia bacteriana na análise multivariada. Houve uma redução significativa da ocorrência de provável pneumonia bacteriana e derrame pleural em relação ao estudo anterior: 63% (P < 0,0001) e 80,9% (P < 0,003), respectivamente. A cobertura vacinal de PCV13 foi de 97,3% para a primeira dose e 84,8% para a dose de reforço. Conclusões A PCV13 foi efetiva em reduzir a incidência de pneumonia com consolidação e derrame pleural em crianças menores de 5 anos em Concordia, na Argentina. A vacinação é uma estratégia de saúde pública muito efetiva para reduzir doenças que podem ser evitadas com vacina, com impacto na morbidade e nas internações hospitalares.

Uso de la Escala Clínica de Infección Pulmonar para valorar pacientes con ventilación mecánica asistida / Use of the Clinical Pulmonary Infection Score to patients with mechanical ventilation

AbstractIntroduction: Ventilator-associated pneumonia (VAP) is a lung infection that occurs 48 hours or more after endotracheal intubation in patients undergoing mechanical ventilation.Objective: To use the Clinical Pulmonary Infection Score (CPIS) in order to identify the presence of VAP in patients with endotracheal intubation.Methods: Descriptive, cross-sectional study, which included 53 patients with mechanical ventilation, out of which only 11 met the selection criteria. Patients were assessed with the CPIS, as well as with their results of blood count, chest X-ray, and culture of endotracheal aspirates.Results: 81.9% were male, with a mean age of 65.09 ± 13.4 years, weight 75.7 ± 13.5 kg, height 1.61 ± 0.21 cm. The main cause of mechanical ventilation was neurological in 36.4%, and pulmonary in 27.3%. Of all the microorganisms isolated, the one with the highest estimated rate was Pseudomonas aeruginosa. Enterobacter cloacae and Pseudomonas aeruginosa showed drug resistance to all antibiotics.Conclusion: The use of the scale for evaluating patients with mechanical ventilation helps to identify the presence of ventilator-associated pneumonia.

Pneumococcal pneumonia in adults 60 years or older: Incidence, mortality and prevention.

BACKGROUND: This study investigated the burden (incidence, mortality and serotype distribution) of pneumococcal pneumonia among older adults in the region of Tarragona (Spain). METHODS: Population-based cohort study involving 27,204 individuals ≥60 years in Tarragonès county (Southern Catalonia), who were prospectively followed between 01/12/2008 and 30/11/2011. Bacteremic and nonbacteremic (positive sputum culture and/or urinary antigen test) pneumococcal pneumonias were recruited. RESULTS: A total of 125 pneumococcal pneumonias (16 bacteremic and 109 nonbacteremic) was observed. Incidence rates (per 1000 person-years) were 0.21 (95% confidence interval [CI]: 0.13-0.35) for bacteremic cases and 1.45 (95% CI: 1.20-1.75) for nonbacteremic cases. Case-fatality rate was 10.4% (12.5% in bacteremic and 10.1% in nonbacteremic cases). Five serotypes (types 3, 6C, 19A, 22F and 35B) were the most common serotypes, accounting for 64.3% of overall isolated serotypes. 73.1% of cases were due to the strains included in the 23-valent vaccine whereas 53.6% were due to the strains included in the 13-valent vaccine. CONCLUSION: The burden of pneumococcal pneumonia remains considerable (especially among oldest people and nursing-home residents) despite a publicly funded anti-pneumococcal vaccination program operative for several years.

Alcohol Use Disorders and Community-Acquired Pneumococcal Pneumonia: Associated Mortality, Prolonged Hospital Stay and Increased Hospital Spending.

INTRODUCTION: The aim of this study was to investigate the impact of alcohol use disorders (AUD) on community-acquired pneumococcal pneumonia (CAPP) admissions, in terms of in-hospital mortality, prolonged stay and increased hospital spending. METHODS: Retrospective observational study of a sample of CAPP patients from the minimum basic datasets of 87 Spanish hospitals during 2008-2010. Mortality, length of hospital stay and additional spending attributable to AUD were calculated after multivariate covariance analysis for variables such as age and sex, type of hospital, addictions and comorbidities. RESULTS: Among 16,202 non-elective admissions for CAPP in patients aged 18-74years, 2,685 had AUD. Patients admitted with CAPP and AUD were predominantly men with a higher prevalence of tobacco or drug use disorders and higher Charlson comorbidity index. Patients with CAPP and AUD had notably higher in-hospital mortality (50.8%; CI95%: 44.3-54.3%), prolonged length of stay (2.3days; CI95%: 2.0-2.7days) and increased costs (1,869.2€; CI95%: 1,498.6-2,239.8€). CONCLUSIONS: According to the results of this study, AUD in CAPP patients was associated with increased in-hospital mortality, length of hospital stay and hospital spending.

Infección invasiva por Streptococcus pneumoniae: reporte de caso de un paciente con síndrome de Austrian / Invasive Streptococcus pneumoniae infection (Austrian syndrome): a case report

Descrito inicialmente en 1957 por Robert Austrian, el síndrome que lleva su nombre se define como la tríada de neumonía, endocarditis y meningitis secundarias a una infección invasiva por Streptococcus pneumoniae . Desde entonces, y debido a su infrecuencia, se han reportado muy pocos casos en la literatura científica. A continuación se presenta el caso de un paciente de 61 años de edad con un cuadro inicial de meningitis bacteriana por S. pneumoniae , acompañado de neumonía bacteriana e insuficiencia mitral grave asociada a cuatro vegetaciones sobre la cara auricular de la valva posterior, con ruptura y prolapso de su festón central posterior. Se aisló S. pneumoniae , serotipo 18C, en líquido cefalorraquídeo y en dos hemocultivos. El paciente recibió antibióticos de amplio espectro y fue sometido a reemplazo valvular temprano con un resultado clínico satisfactorio. El principal factor pronóstico de esta condición lo determina el daño valvular subsecuente, sobre todo en pacientes con compromiso de la válvula aórtica, por lo que es necesario identificar tempranamente la extensión del compromiso valvular y definir oportunamente el tratamiento quirúrgico y antibiótico del paciente. En casos menos frecuentes, en los que solo hay compromiso de la válvula mitral, la evolución clínica es menos aguda y, por lo general, el tratamiento antibiótico dirigido y las medidas de soporte avanzado suelen ser suficientes para su control.

Austrian syndrome is defined as the triad consisting of pneumonia, endocarditis and meningitis due to invasive Streptococcus pneumoniae infection. Few case reports have been reported since its first description in 1975 by Robert Austrian, mainly because it is rarely observed. Below we report the case of a 61 year-old male patient who presented with bacterial meningitis due S. pneumoniae followed by bacterial pneumonia and severe mitral regurgitation, associated with four vegetations on the atrial surface of the posterior mitral leaflet; in addition, there was rupture and prolapse of its middle scallop. The S. pneumoniae bacterium was isolated from cerebrospinal fluid and blood cultures. In consequence, the patient was given broad-spectrum antibiotic therapy and had an early valve replacement performed, obtaining a good clinical outcome. The key prognostic factor of the Austrian syndrome is determined by the damage of cardiac valves, particularly in patients with a compromised aortic valve; hence, it is necessary to identify the degree of valve injury and define surgical and antibiotic treatment on a timely fashion. However, in subacute, less frequent clinical cases where the mitral valve is the main valve compromised, usually a directed antibiotic therapy associated with advanced support measures are sufficient to control this infection.

Neumonía Neumocócica Bacteriémica en el adulto / Bacteremic Pneumococcal pneumonia in adult

Objetivo: el objetivo del trabajo fue describir los resultados encontrados en los pacientes con neumonía neumocócica bacteriémica en nuestro medio y compararlos con otros ensayos similares. Pacientes y métodos: se realizó un estudio observacional retrospectivo de pacientes mayores de 15 años con neumonía aguda de la comunidad o neumonía intrahospitalaria con al menos un hemocultivo positivo para S. pneumoniae, internados desde enero 2004 hasta diciembre 2010. Resultados: se registraron 93 pacientes, 70 varones y 23 mujeres con una edad promedio de 50 años. La incidencia fue de siete casos cada 1.000 ingresos. Ningún paciente había recibido la vacuna antineumocócica antes de la internación. Se registraron 20 pacientes con HIV positivo y 5 pacientes con neumonía neumocócica intrahospitalaria. Los hábitos y comorbilidades más frecuente fueron el tabaquismo, etilismo, diabetes mellitus, EPOC, HIV y hepatopatía. Se constató en el grupo de bajo riesgo 42 pacientes. Se encontraron 87 muestras sensibles a penicilina, Se detectó una mortalidad del 9.6% y un promedio de once días de internación. El análisis multivariado determinó a las variables shock séptico y el alcoholismo como factores de riesgo de mortalidad. En 80 pacientes se redujo el tratamiento empírico endovenoso y en 46 se realizó de manera óptima. Conclusión: se describió en el trabajo la alta incidencia de neumonía neumocócica bacteriémica, los bajos niveles de resistencia del S. pneumoniae a la penicilina, la elevada reducción óptima antibiótica y el shock séptico y el alcoholismo como factores de riesgo de mortalidad

Objective: The objective was to describe the results found in patients with bacteremic pneumococcal pneumonia in our environment and compare them with similar trials. Patients and Methods: A retrospective observational study of patients older than 15 years with acute community-acquired pneumonia or hospital-acquired pneumonia with at least one positive blood culture for S. pneumoniae, admitted from January 2004 to December 2010 was performed. Results: 93 patients, 70 males and 23 females were recorded with an average age of 50 years. The incidence was seven cases per 1000 admissions. No patient had received pneumococcal vaccine before admission. 20 HIV positive patients and 5 patients with nosocomial pneumococcal pneumonia were recorded. Habits and most frequent comorbidities were smoking, alcohol consumption, diabetes mellitus, COPD, HIV and liver disease. It was found in the group of 42 low-risk patients. 87 penicillin-sensitive samples were found, a mortality of 9.6% and an average of eleven days in hospital was detected. Multivariate analysis determined the septic shock variables and alcohol as risk factors for mortality. In 80 patients the treatment was reduced empirical intravenous and 46 was performed optimally. Conclusion: the work described in the high incidence of bacteremic pneumococcal pneumonia, low levels of resistance of S. pneumoniae to penicillin, high optimal reduction and septic shock antibiotic and alcohol as risk factors for mortality

Síndrome hemolítico urémico secundario a neumonía neumocócica. Presentación de un caso / Hemolytic Uremic Syndrome Associated with Pneumococcal Pneumonia. A Case Report

El síndrome hemolítico urémico es una afección que se caracteriza por anemia hemolítica microangiopática, trombocitopenia e insuficiencia renal aguda. En su forma clásica está asociado a diarrea y tiene un buen pronóstico. Cuando tiene como base una enfermedad neumocócica invasiva, tiene una mortalidad del 25 % y la mitad de los casos que sobreviven evolucionan a una enfermedad renal terminal. Se presenta el caso un niño de 17 meses con síndrome hemolítico urémico secundario a una neumonía con empiema, que después de 10 días en anuria y sometido a diálisis peritoneal intensiva, logró una función renal normal. El éxito en el tratamiento, unido a que no se encontaron casos similares publicados en la provincia, motivó la realización de este trabajo.

Hemolytic uremic syndrome is a condition characterized by hemolytic microangiopathic anemia, thrombocytopenia and acute renal failure. In its classic form it is associated with diarrhea and it has a good prognosis. When there is an invasive pneumococcal disease as underlying condition, it has a mortality rate of 25%, and half of the surviving cases develop end-stage renal disease (ESRD). We present the case of a 17-month-old child with hemolytic uremic syndrome secondary to pneumonia with empyema, who after being anuric and in intensive peritoneal dialysis for 10 days achieved normal renal function. His successful treatment, along with the fact that there are no similar cases published in our province, encouraged us to carry out this work.

Síndrome hemolítico urémico secundario a neumonía neumocócica: presentación de un caso / Hemolytic uremic syndrome associated with pneumococcal pneumonia: a case report

El síndrome hemolítico urémico es una afección que se caracteriza por anemia hemolítica microangiopática, trombocitopenia e insuficiencia renal aguda. En su forma clásica está asociado a diarrea y tiene un buen pronóstico. Cuando tiene como base una enfermedad neumocócica invasiva, tiene una mortalidad del 25 por ciento y la mitad de los casos que sobreviven evolucionan a una enfermedad renal terminal. Se presenta el caso un niño de 17 meses con síndrome hemolítico urémico secundario a una neumonía con empiema, que después de 10 días en anuria y sometido a diálisis peritoneal intensiva, logró una función renal normal. El éxito en el tratamiento, unido a que no se encontaron casos similares publicados en la provincia, motivó la realización de este trabajo(AU)

Hemolytic uremic syndrome is a condition characterized by hemolytic microangiopathic anemia, thrombocytopenia and acute renal failure. In its classic form it is associated with diarrhea and it has a good prognosis. When there is an invasive pneumococcal disease as underlying condition, it has a mortality rate of 25 percent, and half of the surviving cases develop end-stage renal disease (ESRD). We present the case of a 17-month-old child with hemolytic uremic syndrome secondary to pneumonia with empyema, who after being anuric and in intensive peritoneal dialysis for 10 days achieved normal renal function. His successful treatment, along with the fact that there are no similar cases published in our province, encouraged us to carry out this work(AU)

Hospitalization rates for pneumococcal disease in Brazil, 2004 - 2006 / Hospitalizações por doença pneumocócica no Brasil, 2004 - 2006 / Hospitalizaciones por enfermedad neumocócica en Brasil, 2004-2006

OBJECTIVE: To estimate hospitalization rates for pneumococcal disease based on the Brazilian Hospital Information System (SIH). METHODS: Descriptive study based on the Hospital Information System of Brazilian National Health System data from January 2004 to December 2006: number of hospitalizations and deaths for pneumococcal meningitis, pneumococcal sepsis, pneumococcal pneumonia and Streptococcus pneumoniae as the cause of diseases reported in Brazil. Data from the 2003 Brazilian National Household Survey were used to estimate events in the private sector. Pneumococcal meningitis cases and deaths reported to the Notifiable Diseases Information System during the study period were also analyzed. RESULTS: Pneumococcal disease accounted for 34,217 hospitalizations in the Brazilian National Health System (0.1 percent of all hospitalizations in the public sector). Pneumococcal pneumonia accounted for 64.8 percent of these hospitalizations. The age distribution of the estimated hospitalization rates for pneumococcal disease showed a "U"-shape curve with the highest rates seen in children under one (110 to 136.9 per 100,000 children annually). The highest hospital case-fatality rates were seen among the elderly, and for sepsis and meningitis. CONCLUSIONS: PD is a major public health problem in Brazil. The analysis based on the SIH can provide an important input to pneumococcal disease surveillance and the impact assessment of immunization programs.

OBJETIVO: Estimar as hospitalizações por doença pneumocócica com base em dados do Sistema de Informações Hospitalares (SIH). MÉTODOS: Estudo descritivo com base em dados do SIH de janeiro de 2004 a dezembro de 2006: números de hospitalizações e mortes por meningite pneumocócica, sepse pneumocócica, pneumonia pneumocócicca e Streptococcus pneumoniae como causa de doenças ocorridas no Brasil. Dados da Pesquisa Nacional por Amostras de Domicílios 2003 foram utilizados para o setor privado. Casos e mortes por meningite pneumocócica notificados no Sistema Nacional de Agravos de Notificação no mesmo período também foram analisados. RESULTADOS: A doença pneumocócica foi responsável por 34.217 hospitalizações no Sistema Único de Saúde (0,1 por cento de todas as hospitalizações). Pneumonia pneumocócica foi responsável por 64,8 por cento dessas hospitalizações. A distribuição das estimativas de hospitalizações segundo faixa etária mostrou curva em "U", com maior freqüência entre crianças < 1 ano (110-136,9/100.000 crianças/ano). A letalidade hospitalar foi mais alta entre idosos, e entre casos de meningite e sepse. CONCLUSÕES: Doença pneumocócica é importante problema de saúde pública no Brasil. Análise baseada no SIH pode contribuir para a vigilância epidemiológica da doença pneumocócica e para a avaliação do impacto do programa de vacinação.

OBJETIVO: Estimar las hospitalizaciones por enfermedad neumocócica con base en datos del Sistema de Informaciones Hospitalarias (SIH). MÉTODOS: Estudio descriptivo con base en datos del SIH de enero de 2004 a diciembre de 2006: números de hospitalizaciones y muertes por meningitis neumocócica, sepsis neumocócica, neumonía neumocócica y Streptococcus pneumoniae como causa de enfermedades ocurridas en Brasil. Datos de la Investigación Nacional por Muestras de Domicilios 2003 fueron utilizados para el sector privado. Casos y muertes por meningitis neumocócica notificados en el Sistema Nacional de Agravios de Notificación en el mismo período también fueron analizados. RESULTADOS: La enfermedad neumocócica fue responsable por 34.217 hospitalizaciones en el Sistema Único de Salud, (0,1 por ciento de todas las hospitalizaciones). Neumonía neumocócica fue responsable por 64,8 por ciento de tales hospitalizaciones. La distribución de las estimaciones de hospitalizaciones según grupo etáreo mostró curva en "U", con mayor frecuencia entre niños < 1 año (110-136,9/100.000 niños/año). La letalidad hospitalaria fue más alta entre ancianos, y entre casos de meningitis y sepsis. CONCLUSIONES: Enfermedad neumocócica es importante problema de salud pública en Brasil. Análisis basado en el SIH puede contribuir para la vigilancia epidemiológica de la enfermedad neumocócica y para la evaluación del impacto del programa de vacunación.

Evaluating the costs of pneumococcal disease in selected Latin American countries

OBJECTIVES: To estimate the costs of pneumococcal disease in Brazil, Chile and Uruguay, to describe how these costs vary between different patient groups, and to discuss factors that affect these cost variations. METHODS: The cost of pneumococcal disease was estimated from the health care perspective. For each country, baseline cost estimates were primarily developed using health resources information from patient-level data and facility-specific cost data. A regression model was constructed separately for four types of pneumococcal diseases. The skewness-kurtosis test and the Cook-Weisberg test were performed to test the normality of the residuals and the heteroscedasticity, respectively. RESULTS: The treatment of pneumococcal meningitis generated up to US$ 5 435 per child. The treatment costs of pneumococcal pneumonia were lower, ranging from US$ 372 per child to US$ 3 483 per child. Treatment of acute otitis media cost between US$ 20 per child and US$ 217 per child. The main source of treatment costs variations was level of service provided and country in which costs were incurred. However, the tendency of costs to change with these variables was not statistically significant at the 5 percent level for most pneumococcal disease models. CONCLUSIONS: Pneumococcal disease resulted in significant economic burden to selected health care systems in Latin America. The patterns of treatment cost of pneumococcal disease showed a great deal of variation.

OBJETIVOS: Estimar los costos de la enfermedad neumocócica en Brasil, Chile y Uruguay, describir cómo varían estos costos entre diferentes grupos de pacientes y discutir los factores que influyen en las variaciones de estos costos. MÉTODOS: El costo de la enfermedad neumocócica se estimó desde la perspectiva de la atención sanitaria. Inicialmente se establecieron estimados de referencia de los costos para cada país a partir de la información de los recursos sanitarios empleados, según los datos de cada paciente y los costos específicos de cada institución. Se construyeron modelos de regresión por separado para cuatro tipos de enfermedad neumocócica. Se realizaron las pruebas de asimetría-curtosis y de Cook-Weisberg para comprobar la normalidad de los residuos y la heterocedasticidad, respectivamente. RESULTADOS: El costo del tratamiento de la meningitis neumocócica fue de US$ 5 435 por cada niño, mientras el de la neumonía neumocócica fue menor, entre US$ 372 y US$ 3 483 por niño. El costo del tratamiento de la otitis media aguda fue de US$ 20 a US$ 217 por niño. La principal fuente de variación en los costos de tratamiento fue el nivel de servicio brindado y el país en que se generaron los costos. No obstante, la tendencia de los costos a variar no fue estadísticamente significativa (P > 0,05) en la mayoría de los modelos de la enfermedad neumocócica. CONCLUSIONES: La enfermedad neumocócica constituye una notable carga económica para los sistemas de salud seleccionados de América Latina. Los patrones del costo de tratamiento de la enfermedad neumocócica mostraron una gran variación.