Neumonía neumocócica en la era de la vacuna conjugada heptavalente / Pneumococcal pneumonia in the era of heptavalent pneumococcal conjugate

RESUMEN

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)

ABSTRACT

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)