Vigilancia de serotipos en infecciones invasivas por Haemophilus influenzae en la Argentina en la era de la vacuna conjugada contra el serotipo b durante el período 2005-2010 / Surveillance of Haemophilus influenzae serotypes in Argentina from 2005 to 2010 during the Haemophilus influenzae type b conjugate vaccine era

La introducción de la vacuna contra Haemophilus influenzae tipo b en los programas de inmunización de muchos países produjo una reducción marcada en la incidencia de enfermedad invasiva causada por este serotipo y en su portación y un incremento de otros tipos capsulares y de aislamientos no capsulados. Se estudiaron 313 aislamientos de H. influenzae recuperados de sitio estéril, provenientes de pacientes pediátricos y adultos con enfermedad invasiva atendidos en 90 hospitales de la Red Nacional de Laboratorios para Meningitis e Infecciones Respiratorias Agudas Bacterianas durante el período 2005-2010. Las patologías más frecuentes fueron neumonía, 40,3 % (n = 126), meningitis, 30,0 % (n = 94) y bacteriemia, 26,5 % (n = 83). En los pacientes pediátricos (n = 279), la mayor frecuencia de aislamientos correspondió a menores de 2 años, 74,5 % (n = 208). Con respecto a la distribución de tipos, el 61,3 %, correspondió a H. influenzae no capsulados (n = 192); el 20,1 % al b (n = 63); 11,2 % al a (n = 35); 4,8 % al f y 2,6 % a otros. En meningitis predominaron H. influenzae capsulados mientras que en neumonía y bacteriemia resultaron dominantes los tipos no capsulados. Se determinó el biotipo en 306 aislamientos. Todos los aislamientos de tipo a correspondieron al biotipo II; el 66,7 % de los tipo b pertenecieron al biotipo I. Mediante las técnicas de aglutinación en lámina y PCR se estudiaron 220 aislamientos; la concordancia entre ambas fue de 0,982 (IC: 0,92-1,00). En el último año se encontró un aumento significativo del tipo b, lo cual indica la importancia de mantener la vigilancia clínica y laboratorial de la enfermedad invasiva por H. influenzae.

The introduction of the Haemophilus influenzae type b vaccine in the immunization programs of many countries has greatly reduced this invasive disease and the carriage caused by this serotype, also increasing other capsular types and non-capsular isolations. There were 313 isolations of H. influenzae under study, which were recovered from a sterile site coming from pediatric and adult patients carrying the invasive disease. Patients were treated at 90 different hospitals belonging to the Red Nacional de Laboratorios para Meningitis e Infecciones Respiratorias Agudas Bacterianas (National Lab Network for Meningitis and Acute Bacterial Respiratory Infections) from 2005 to 2010 for the following disorders: pneumonia, 40.3% (n = 126), meningitis, 30.0% (n = 94) and bacteremia, 26.5% (n = 83). In pediatric patients (n = 279), the highest frequency of isolations corresponded to children under the age of 2 years, 74.5% (n = 208). Regarding type distribution, 61.3% corresponded to non-capsular H. influenzae (n = 192), 20.1% to type b (n = 63), 11.2% to type a (n = 35), 4.8% to type f, and 2.6% to other types. Capsular H. influenzae was predominant in meningitis whereas non-capsular H. influenzae in pneumonia and bacteremia. The biotype was determined in 306 isolations. The totality (100%) of type a (n = 35) was biotype II whereas 66.7% of type b (n = 63) was biotype I. Slide agglutination and PCR tests were used in 220 isolations. There was a match of 0.982 (IC: 0.92-1.00) between them. During the last year, there was a great increase in type b, showing the importance of clinical and laboratory-based surveillance of the invasive disease caused by H. influenzae.

Vigilancia de serotipos en infecciones invasivas por Haemophilus influenzae en la Argentina en la era de la vacuna conjugada contra el serotipo b durante el período 2005-2010 / Surveillance of Haemophilus influenzae serotypes in Argentina from 2005 to 2010 during the Haemophilus influenzae type b conjugate vaccine era

La introducción de la vacuna contra Haemophilus influenzae tipo b en los programas de inmunización de muchos países produjo una reducción marcada en la incidencia de enfermedad invasiva causada por este serotipo y en su portación y un incremento de otros tipos capsulares y de aislamientos no capsulados. Se estudiaron 313 aislamientos de H. influenzae recuperados de sitio estéril, provenientes de pacientes pediátricos y adultos con enfermedad invasiva atendidos en 90 hospitales de la Red Nacional de Laboratorios para Meningitis e Infecciones Respiratorias Agudas Bacterianas durante el período 2005-2010. Las patologías más frecuentes fueron neumonía, 40,3 % (n = 126), meningitis, 30,0 % (n = 94) y bacteriemia, 26,5 % (n = 83). En los pacientes pediátricos (n = 279), la mayor frecuencia de aislamientos correspondió a menores de 2 años, 74,5 % (n = 208). Con respecto a la distribución de tipos, el 61,3 %, correspondió a H. influenzae no capsulados (n = 192); el 20,1 % al b (n = 63); 11,2 % al a (n = 35); 4,8 % al f y 2,6 % a otros. En meningitis predominaron H. influenzae capsulados mientras que en neumonía y bacteriemia resultaron dominantes los tipos no capsulados. Se determinó el biotipo en 306 aislamientos. Todos los aislamientos de tipo a correspondieron al biotipo II; el 66,7 % de los tipo b pertenecieron al biotipo I. Mediante las técnicas de aglutinación en lámina y PCR se estudiaron 220 aislamientos; la concordancia entre ambas fue de 0,982 (IC: 0,92-1,00). En el último año se encontró un aumento significativo del tipo b, lo cual indica la importancia de mantener la vigilancia clínica y laboratorial de la enfermedad invasiva por H. influenzae.(AU)

The introduction of the Haemophilus influenzae type b vaccine in the immunization programs of many countries has greatly reduced this invasive disease and the carriage caused by this serotype, also increasing other capsular types and non-capsular isolations. There were 313 isolations of H. influenzae under study, which were recovered from a sterile site coming from pediatric and adult patients carrying the invasive disease. Patients were treated at 90 different hospitals belonging to the Red Nacional de Laboratorios para Meningitis e Infecciones Respiratorias Agudas Bacterianas (National Lab Network for Meningitis and Acute Bacterial Respiratory Infections) from 2005 to 2010 for the following disorders: pneumonia, 40.3% (n = 126), meningitis, 30.0% (n = 94) and bacteremia, 26.5% (n = 83). In pediatric patients (n = 279), the highest frequency of isolations corresponded to children under the age of 2 years, 74.5% (n = 208). Regarding type distribution, 61.3% corresponded to non-capsular H. influenzae (n = 192), 20.1% to type b (n = 63), 11.2% to type a (n = 35), 4.8% to type f, and 2.6% to other types. Capsular H. influenzae was predominant in meningitis whereas non-capsular H. influenzae in pneumonia and bacteremia. The biotype was determined in 306 isolations. The totality (100%) of type a (n = 35) was biotype II whereas 66.7% of type b (n = 63) was biotype I. Slide agglutination and PCR tests were used in 220 isolations. There was a match of 0.982 (IC: 0.92-1.00) between them. During the last year, there was a great increase in type b, showing the importance of clinical and laboratory-based surveillance of the invasive disease caused by H. influenzae.(AU)

Otitis media aguda: prevalencia de otopatógenos en pacientes de un hospital público / Acute otitis media: prevalence of ear pathogens in patients at a public hospital

Introducción y objetivo: La otitis media aguda (OMA) es una de las afecciones más frecuentes en la infancia y es la causa más común de prescripción de antibióticos en pediatría. El método indicado para identificar el germen responsable en OMA es la obtención de material del oído medio para cultivo mediante timpanocentesis. El objetivo de este estudio es describir la prevalencia de gérmenes causantes de OMA en pacientes eutróficos de 1 a 120 meses, que consultaron en un hospital público pediátrico. Método: Se incluyeron pacientes eutróficos con OMA con retención de contenido purulento en oído medio y OMA supurada con drenaje insuficiente de exudado que consultaron al Servicio de Otorrinolaringología de un hospital pediátrico desde mayo del 2009 hasta agosto del 2010. Resultados: Se incluyeron en el estudio 324 pacientes de los cuales 180 (55,6%) eran varones. Mediana de edad: 8 meses (rango intercuartílico: 4-15 meses). OMA bilateral se registró en 109/324 (33,6%) pacientes (se obtuvieron 433 muestras para cultivo).Al momento del diagnóstico 37% (120/324) de los niños recibían antibioticoterapia. De estos, el 59% (71/120) presentaron desarrollo bacteriano en los cultivos. La antibioticoterapia era adecuada en el 71,8% de los casos; en el 28,2% restante no se cubría el espectro del germen aislado. Conclusión: Los microorganismos más frecuentemente aislados fueron Streptococcus pneumoniae (39,5%), Haemophilus influenzae (37,4%), Moraxella catarrhalis (6,1%) y Streptococcus pyogenes (3,0%) (AU)

Background and objective: Acute otitis media (AOM) is one of the most common diseases in childhood and is the most common cause of antibiotic prescriptions in children. The gold standard for identifying the pathogens causing AOM is tympanocentesis. This is only possible in the stage of AOM when exudate is retained in the middle ear. The aim of this study was to describe the prevalence of organisms causing AOM in eutrophic patients at a public paediatric hospital. Material and methods: We included all patients with AOM diagnosed by otomicroscopy with purulent exudate retained in middle ear and suppurative AOM with inadequate drainage consulting at the Otorhinolaryngology Department in a paediatric tertiary care centre from 2 May 2009 to 31 August 2010. Results: There were 324 patients included in the study, with 180/324 (55.6%) being male. The median age was 8 months (interquartile range: 4 to 15 months). Bilateral AOM was recorded in 109/324 (33.6%) patients (433 samples for culture were obtained by tympanocentesis in 324 patients). At diagnosis, 37% (120/324) of the children had been receiving antimicrobial treatment. Of the patients who had received antibiotics, 71/120 (59.1%) had bacterial growth in middle ear fluid (MEF) cultures, with 51/71 (71.8%) being susceptible to the antibiotic they received; 20/71 (28.2%) patients were receiving an antibiotic that did not cover the spectrum of organisms isolated. Conclusion: The pathogens most frequently isolated are Streptococcus pneumoniae (39.5%), Haemophilus influenzae (37.4%), Moraxella catarrhalis (6.1%) and Streptococcus pyogenes (3.0%) (AU)

[Acute otitis media: prevalence of ear pathogens in patients at a public hospital]. / Otitis media aguda: prevalencia de otopatógenos en pacientes de un hospital público.

BACKGROUND AND OBJECTIVE: Acute otitis media (AOM) is one of the most common diseases in childhood and is the most common cause of antibiotic prescriptions in children. The gold standard for identifying the pathogens causing AOM is tympanocentesis. This is only possible in the stage of AOM when exudate is retained in the middle ear. The aim of this study was to describe the prevalence of organisms causing AOM in eutrophic patients at a public paediatric hospital. MATERIAL AND METHODS: We included all patients with AOM diagnosed by otomicroscopy with purulent exudate retained in middle ear and suppurative AOM with inadequate drainage consulting at the Otorhinolaryngology Department in a paediatric tertiary care centre from 2 May 2009 to 31 August 2010. RESULTS: There were 324 patients included in the study, with 180/324 (55.6%) being male. The median age was 8 months (interquartile range: 4 to 15 months). Bilateral AOM was recorded in 109/324 (33.6%) patients (433 samples for culture were obtained by tympanocentesis in 324 patients). At diagnosis, 37% (120/324) of the children had been receiving antimicrobial treatment. Of the patients who had received antibiotics, 71/120 (59.1%) had bacterial growth in middle ear fluid (MEF) cultures, with 51/71 (71.8%) being susceptible to the antibiotic they received; 20/71 (28.2%) patients were receiving an antibiotic that did not cover the spectrum of organisms isolated. CONCLUSION: The pathogens most frequently isolated are Streptococcus pneumoniae (39.5%), Haemophilus influenzae (37.4%), Moraxella catarrhalis (6.1%) and Streptococcus pyogenes (3.0%).

[Surveillance of Haemophilus influenzae serotypes in Argentina from 2005 to 2010 during the Haemophilus influenzae type b conjugate vaccine era]. / Vigilancia de serotipos en infecciones invasivas por Haemophilus influenzae en la Argentina en la era de la vacuna conjugada contra el serotipo b durante el período 2005-2010.

The introduction of the Haemophilus influenzae type b vaccine in the immunization programs of many countries has greatly reduced this invasive disease and the carriage caused by this serotype, also increasing other capsular types and non-capsular isolations. There were 313 isolations of H. influenzae under study, which were recovered from a sterile site coming from pediatric and adult patients carrying the invasive disease. Patients were treated at 90 different hospitals belonging to the Red Nacional de Laboratorios para Meningitis e Infecciones Respiratorias Agudas Bacterianas (National Lab Network for Meningitis and Acute Bacterial Respiratory Infections) from 2005 to 2010 for the following disorders: pneumonia, 40.3% (n=126), meningitis, 30.0% (n=94) and bacteremia, 26.5% (n=83). In pediatric patients (n=279), the highest frequency of isolations corresponded to children under the age of 2 years, 74.5% (n=208). Regarding type distribution, 61.3% corresponded to non-capsular H. influenzae (n=192), 20.1% to type b (n=63), 11.2% to type a (n=35), 4.8% to type f, and 2.6% to other types. Capsular H. influenzae was predominant in meningitis whereas non-capsular H. influenzae in pneumonia and bacteremia. The biotype was determined in 306 isolations. The totality (100%) of type a (n=35) was biotype II whereas 66.7% of type b (n=63) was biotype I. Slide agglutination and PCR tests were used in 220 isolations. There was a match of 0.982 (IC: 0.92-1.00) between them. During the last year, there was a great increase in type b, showing the importance of clinical and laboratory-based surveillance of the invasive disease caused by H. influenzae.

Vigilancia de serotipos en infecciones invasivas por Haemophilus influenzae en la Argentina en la era de la vacuna conjugada contra el serotipo b durante el período 2005-2010. / [Surveillance of Haemophilus influenzae serotypes in Argentina from 2005 to 2010 during the Haemophilus influenzae type b conjugate vaccine era].

The introduction of the Haemophilus influenzae type b vaccine in the immunization programs of many countries has greatly reduced this invasive disease and the carriage caused by this serotype, also increasing other capsular types and non-capsular isolations. There were 313 isolations of H. influenzae under study, which were recovered from a sterile site coming from pediatric and adult patients carrying the invasive disease. Patients were treated at 90 different hospitals belonging to the Red Nacional de Laboratorios para Meningitis e Infecciones Respiratorias Agudas Bacterianas (National Lab Network for Meningitis and Acute Bacterial Respiratory Infections) from 2005 to 2010 for the following disorders: pneumonia, 40.3

(n=126), meningitis, 30.0

(n=94) and bacteremia, 26.5

(n=83). In pediatric patients (n=279), the highest frequency of isolations corresponded to children under the age of 2 years, 74.5

(n=208). Regarding type distribution, 61.3

corresponded to non-capsular H. influenzae (n=192), 20.1

to type b (n=63), 11.2

to type a (n=35), 4.8

to type f, and 2.6

to other types. Capsular H. influenzae was predominant in meningitis whereas non-capsular H. influenzae in pneumonia and bacteremia. The biotype was determined in 306 isolations. The totality (100

) of type a (n=35) was biotype II whereas 66.7

of type b (n=63) was biotype I. Slide agglutination and PCR tests were used in 220 isolations. There was a match of 0.982 (IC: 0.92-1.00) between them. During the last year, there was a great increase in type b, showing the importance of clinical and laboratory-based surveillance of the invasive disease caused by H. influenzae.