RESUMO
The increasing prevalence of advanced chronic respiratory disease, with frequent exposure to broad-spectrum antibiotics for repeated and prolonged hospitalizations, favours the emergence of nosocomial respiratory infection by Gram-positive bacteria, such as outbreaks of Corynebacterium striatum. There is little evidence about patterns of respiratory infection, transmission and adaptive ability of this pathogen. Seventy-two C. striatum isolates from 51 advanced respiratory patients, mainly chronic obstructive pulmonary disease, were studied during 38 months. Patients were 74.8 ± 8.6 years old and 81.9% were men, who had required an average of 2.2 hospitalizations and 63.5 days in the hospital in the previous year. Of 49 isolates from 42 patients we were able to identify 12 clones by multilocus sequence analysis (MLSA), nine phenotypic variants and 22 antibiotic susceptibility patterns, and we determined their clinical and epidemiological determinants. MLSA allows identification of the existence of nosocomial outbreaks by transmission of the same or different clones, the persistence of the same clone in the environment or in patient airways for months. The study showed the high variability and adaptive capacity of the isolates, the antibiotic multidrug-resistance in all of them, and their contribution to a high morbidity and mortality (41%) during the study period.
RESUMO
Introducción: Describir las características clínicas, las complicaciones, los serotipos y las resistencias antibióticas en la neumonía neumocócica en nuestro medio tras la generalización de la vacuna conjugada heptavalente (VNC-7) en pediatría. Material y métodos: Estudio prospectivo de los episodios de neumonía neumocócica, con cultivos positivos, en pacientes atendidos en urgencias desde enero de 2006 hasta febrero de 2010.Resultados: Se estudiaron 346 episodios en 320 pacientes; 335 correspondían a 309 pacientes adultos,221 (71,5%) varones, mediana de edad 68 años (rango: 16-94) y 11 episodios a pacientes < 15 años. Fueron de adquisición comunitaria 237 episodios (68,5%). Presentaron bacteriemia 130 (37,6%) casos, evidenciando una tendencia al aumento de riesgo en los pacientes < 65 años (OR = 1,56; IC del 95%, 0,96-2,56;p = 0,07). Desarrollaron empiema 13 (3,8%) y shock séptico 33 (9,5%). La media de edad de los pacientes con empiema fue menor (p = 0,03). En el análisis multivariante se relacionaron con la presencia de bacteriemia: antecedente de patología respiratoria = (..) (AU)
Introduction: To describe clinical features, complications, serotypes and antibiotic resistance in pneumococcal pneumonia in our environment after the generalization of the heptavalent conjugate vaccine(PCV-7) in paediatrics. Material and methods: Prospective study of episodes of pneumococcal pneumonia, with positive cultures in patients treated in the emergency department from January 2006 to February 2010.Results: We studied 346 episodes in 320 patients, 335 belonged to 309 adult patients, 221 (71.5%) males, median age 68 years (range 16-94), and 11 episodes to patients < 15 years. Two-hundred and thirty-seven (68.5%) episodes were community acquired. Bacteraemia was present in 130 (37.6%) cases, with a tendency towards an increased risk in patients < 65 years (OR = 1.56, 95% CI 0.96- 2.56, P = .07). Thirteen (3.8%) patients developed empyema and 33 (9.5%) septic shock. The mean age of patients with empyema was lower (P = .03). In the multivariate analysis were related to the presence of bacteraemia: a history of chronic respiratory disease (OR = 0.45, 95% CI 0.25-0.81, P = .008), positive urinary antigen (OR 2.02,95% CI 1 13-3.62, P = .01) and pleural effusion (OR = 3.86, 95% CI 1.79-8.35, P = .001). Shock was associated with Fine IV-V stage (OR = 23.6, 95% CI 4.96-112.82, P < .001), age < 65 years (OR = 4.47, 95% CI 1.75-11.39,P = .002) and pleural effusion (OR = 4.15, 95% CI 1.65 to 10.41, P = .002).Increased mortality risk was associated with presence of any complication (OR = 6.6, 95% CI 1.5-27.2,P = .009) and specifically septic shock (OR = 3.3, 95% CI 1.06-10.3, P = .04). Most serotypes obtained were not included in the VNC-7.Conclusions: Pneumococcal pneumonia after generalisation of PCV-7 is mainly related to non-vaccine serotypes. Younger patients without respiratory disease are at increased risk of bacteraemia, empyema, and septic shock, the latter being associated with a higher mortality (AU)
