THE EFFECTS OF ANTIBIOTIC ON OROPHARYNGEAL PNEUMOCOCCAL COLONIZATION IN CHILDREN WITH UPPER RESPIRATORY TRACT INFECTION IN CHILDREN REFERRED TO BANDAR ABBAS PEDIATRIC HOSPITAL (ID 24)
Abstract
Background
Respiratory tract infection(URI) is one of the most common diseases of childhood . Resistance to antimicrobial agents is becoming a Basic problem in worldwide and in Asia. The aim of our study was to determine the Effects of Antibiotic on Oropharyngeal Pneumococcal Colonization and antibiotic resistace in Children with URI.
Methods
This cross-sectional study was performed in mid 2019, 70 Children ( mean age of 6.92 years)with URI were selected . Nasopharyngeal samples were collected by sterile swaps and then inoculated on selective agar. After 24 h incubation, microbiological tests were performed and antimicrobial sensitivity tests were done.
Results
Of 70 children 27 (38.6%) were boys and 43 (61.4%) were girls and the mean age was 6.92 years . Streptococcus pneumonia was recovered from 14 samples (20%). Antibiotic resistance of the isolates to clindamycin ,co-trimoxazole ,azithromycin, ampicillin, , and ceftriaxone were 28%,21%, 7%,7%, 7% respectively and 28% of isolates were not resistant to any antibiotics.
Conclusions
The results of this study showed that antibiotic consumption and daycare attendance are associated with increased antibiotic resistance
IMPACT OF THE ADDITION OF AZITHOMYCIN TO THE ANTIMALARIALS USED FOR SEASONAL MALARIA CHEMOPREVENTION ON ANTIMICROBIAL RESISTANCE OF STREPTOCOCCUS PNEUMONIAE (ID 231)
CHEST-RADIOGRAPH FINDINGS IN CHILDREN (2-59 MONTHS) HOSPITALIZED WITH COMMUNITY-ACQUIRED PNEUMONIA, PRIOR TO INTRODUCTION OF PNEUMOCOCCAL CONJUGATE VACCINE IN INDIA- A PROSPECTIVE OBSERVATIONAL STUDY (ID 364)
MOLECULAR MECHANISM UNDERLINES THE IMPORTANCE OF PROBIOTIC BACILLUS SUBTILIS TO ELIMINATE PNEUMOCOCCAL PATHOGEN (ID 1043)
Abstract
Background
Probiotic nutrition is frequently claimed to improve human health. In particular, live probiotic bacteria obtained with food are thought to reduce pneumococcal colonization by pathogens in nasopharynx, and thus to reduce susceptibility to infection. However, the mechanism underlying these effects remain poorly understood.
Methods
Nasal samples were collected from 150 patients with expected Pneumococcal infection. Microbiome and growth inhibition analysis were done followed by fengycin purification. Bacillus lipopeptide was performed by RP-HPLC/ESI-MS followed by mouse colonization model.
Results
Here we report that the consumption of probiotic Bacillus subtilis comprehensively abolished colonization by the dangerous pathogen Streptococcus pneumoniae in a rural Pakistani population. Widespread class of Bacillus lipopeptides, the fengycins, eliminates S. pneumoniae by inhibiting S. aureus quorum sensing. Our study presents a detailed molecular mechanism that underlines the importance of probiotic nutrition in reducing infectious disease. The biological significance of probiotic bacterial interference in humans, displayed that such interference can be achieved by blocking a pathogen’s signalling system.
Conclusions
Our findings suggest a probiotic-based method for S. pneumoniae decolonization and new ways to fight S. pneumoniae infections.
ANTIMICROBIAL ACTIVITY OF MEDICINAL PLANT EXTRACTS IN INDONESIA AGAINST MULTI-DRUG RESISTANT STRAIN OF STREPTOCOCCUS PNEUMONIAE (ID 513)
TARGETING ERADICATION OF PNEUMOCOCCAL CARRIAGE WITH FDA-APPROVED DEOXYCHOLIC ACID (ID 828)
Abstract
Background
Nearly 1 billion children worldwide carry Streptococcus pneumoniae (Spn) in the upper airways. Human bile salts are known to dissolve the Spn cell wall of which deoxycholic acid (DoC) is approved by the FDA for aesthetic treatment (10 mg/ml). We investigated the antimicrobial effect of DoC against pneumococcal strains.
Methods
Dose-response and time-course studies were conducted with Spn reference strains (N=2) and MDR strains (N=3). We then challenged Spn strains (N=55), including vaccine types, and other oral bacterial species (N=21) with a MIC90 and viability was investigated. An in-vitro model of pneumococcal colonization assessed the antimicrobial activity in a life-like scenario.
Results
MIC90 was achieved with 0.5 mg/ml of DoC incubated for 2 h with vaccine and non-vaccine type strains and reference strains TIGR4 and D39. The pneumococcal colonization model demonstrated that DoC eradicated 107 cfu/ml of MDR strains bearing resistance to Penicillin, Meropenem, and/or Erythromycin within 20 min post-exposure. Viability of most oral bacterial species was not affected by a treatment with a Spn-MIC90.
Conclusions
DoC eradicated Spn strains with a MIC90 20-fold lower than the recommended human dose. It has the potential for prophylactic eradication of Spn carriage from the upper airways with no disturbance of other oral bacteria.
SUPPORTIVE CARE AND ANTIBIOTICS FOR SEVERE PNEUMONIA AMONG HOSPITALISED CHILDREN (SEARCH): A PRAGMATIC RANDOMISED CONTROLLED TRIAL (ID 1096)
Abstract
Background
Following introduction of vaccines against the dominant bacterial causes of pneumonia, there has been growing debate over the appropriateness of the World Health Organisation (WHO) guidelines for empiric antibiotic treatment in low- and middle-income countries. Evidence is also lacking on the appropriate practice for providing nutritional and fluid management to children with signs of severe respiratory illness. This study will compare amoxicillin-clavulanic acid and ceftriaxone to benzylpenicillin plus gentamicin (standard of care). We will also compare nasogastric feeding to intravenous fluids.
Methods
We are conducting a 3x2 factorial pragmatic randomised controlled trial at 12 hospitals in East Africa. We aim to recruit 4392 children aged 2-59 months admitted with severe pneumonia. The primary outcome will be mortality at day 5 post-enrolment. Secondary outcomes include time taken to be able to drink, length of hospitalisation, adverse events related to the interventions, and mortality at day 30.
Results
Recruitment commenced in August 2019 and is expected to conclude in three years.
Conclusions
This study is expected to generate much-needed evidence to inform policy on the appropriate antibiotic therapy and supportive care interventions for children with severe pneumonia in the post pneumococcal and Haemophilus influenzae conjugate vaccine era.
RESISTANCE OF STREPTOCOCCUS PNEUMONIAE ISOLATES CAUSING INVASIVE PNEUMOCOCCAL DISEASE IN 17 HOSPITALS OF COLOMBIA. (ID 277)
- Aura L. Leal Castro, Colombia
- German Camacho Moreno, Colombia
- Jaime A. Patiño Niño, Colombia
- Vivian M. Moreno Mejia, Colombia
- Ivan F. Gutierrez Tobar, Colombia
- Sandra Beltran, Colombia
- Martha I. Alvarez-Olmos, Colombia
- Cristina Mariño, Colombia
- Rocio Barrero Barreto, Colombia
- Juan P. Rojas, Colombia
- Fabio Espinosa, Colombia
- Catalina Arango, Colombia
- Maria A. Suarez, Colombia
- Monica Trujillo, Colombia
- Eduardo López, Colombia
- Pio López, Colombia
- Wilfrido Coronell, Colombia
- Hernando Pinzon, Colombia
- Nicolas Ramos, Colombia
- Anita Montañez, Colombia
Abstract
Background
Invasive Pneumococcal Disease (IPD) is a cause of morbidity and mortality in children. Some Streptococcus pneumoniae isolates are resistant to antibiotics used for IPD, such as beta-lactams and macrolides. Increased resistance has been reported in Colombia.
Methods
Ambispective case series study in pediatric patients with IPD admitted in 10 hospitals of Bogotá in 2008-2019, and 4 hospitals of Cali, 2 of Medellin and 1 of Cartagena in 2017-2019 (preliminary data).
Results
651 cases of IPD were found. Susceptibility profile information was obtained for 567(87%) isolates; 494(75.8%) were non-meningeal (NM) and 73(11.2%) meningeal (M). Regarding NM, 16.3% were penicillin-resistant, and 5.8% showed intermediate susceptibility; 5% were resistant to ceftriaxone and 9.5% had intermediate susceptibility. M showed 19.1% resistance to penicillin, 5.4% resistance to ceftriaxone, and 5.4% intermediate susceptibility. Resistance to macrolides was 26.2%, to clindamycin 19.7%, and trimethoprim sulfa 32%. All isolates were susceptible to vancomycin. Only 23.8% of the isolates were susceptible to all antibiotics; 36% were multi-resistant. The serotype most resistant to penicillin was 19A (26.8%), which was associated with multi-resistance.
Conclusions
An increase in antibiotic resistance is observed in relation to previous reports associated with emergence of multiresistant S. pneumoniae serotype 19A.
ASSOCIATION BETWEEN PNEUMOCOCCAL CARRIAGE AND ANTIMICROBIAL ACTIVITY IN URINE OF MALAWIAN CHILDREN HOSPITALIZED WITH ACUTE RESPIRATORY INFECTION (ID 445)
Abstract
Background
Following the 2011 introduction of PCV13 in Malawi, 77% of healthy children carry pneumococci in the nasopharynx, while 41% of children hospitalized for acute respiratory infection (ARI) are colonized. We assessed if there is an association between pneumococcal carriage and pre-hospital antibiotic exposure.
Methods
Participants included 69 children aged 1-4 years admitted to Queen Elizabeth Central Hospital, Blantyre, Malawi 2016-2019 due to ARI. Information on pre-hospital antibiotics was collected from parents and/or the child´s health passport. Antimicrobial activity was detected by a urine bioassay. Pneumococci were isolated from a nasopharyngeal sample and tested for antibiotic susceptibility.
Results
Among the 40/69 (58%) samples showing antibiotic activity, 6 (8.7%) were from children with no report of pre-hospital antibiotics. Pneumococci was isolated from 55% of children with urine antimicrobial activity, while carriage was 74% in children with no activity. No difference in pneumococcal penicillin susceptibility was found between children with or without urine antimicrobial activity.
Conclusions
The urine bioassay is a useful tool for assessment of antibiotic exposure in resource limited settings, since patient´s reported history may not be reliable. Pre-hospital antibiotics may explain lower pneumococcal carriage prevalence among those hospitalized compared to healthy. However, pre-hospital antibiotics have not selected for penicillin resistance.
SAFETY AND IMMUNOGENICITY OF V114 ADMINISTERED CONCOMITANTLY WITH INFLUENZA VACCINE (PNEU-FLU) (ID 619)
- Randall Severance, United States of America
- Howard Schwartz, United States of America
- Matthew Davis, United States of America
- Kurt Lesh, United States of America
- Ron Dagan, Israel
- Laurie Connor, United States of America
- Jianing Li, United States of America
- Alison Pedley, United States of America
- Jonathan Hartzel, United States of America
- Tina Sterling, United States of America
- Katrina Nolan, United States of America
- Gretchen Tamms, United States of America
- Luwy Musey, United States of America
- Ulrike Buchwald, United States of America
Abstract
Background
Streptococcus pneumoniae and influenza virus are significant causes of disease worldwide. V114, an investigational 15-valent PCV, contains all serotypes in PCV13 plus serotypes 22F and 33F. This phase 3 trial evaluated safety and immunogenicity of concomitant and non-concomitant administration of V114 and quadrivalent influenza vaccine (QIV) in adults aged ≥50 years.
Methods
Overall, 1200 participants were randomized 1:1 to receive either V114 administered concomitantly with QIV (concomitant group) or V114 administered 1 month after QIV (non-concomitant group); randomization was stratified by age and history of prior pneumococcal polysaccharide vaccine. Pneumococcal serotype-specific opsonophagocytic activity (OPA) and influenza strain-specific hemagglutination inhibition (HAI) antibodies were measured prior and 30 days postvaccination. Demonstration of non-inferior immunogenicity between the concomitant and non-concomitant group required the lower bound of the 95% confidence interval of the ratio of OPA and HAI geometric mean titers (GMTs) to be ≥0.5.
Results
Proportions of participants reporting any AE, injection-site AEs, and systemic AEs were generally comparable between vaccination groups. Non-inferiority was demonstrated for all 15 pneumococcal serotypes and all 4 influenza strains between vaccination groups.
Conclusions
V114 administered concomitantly with QIV was generally well tolerated and immunologically non-inferior to non-concomitant administration, supporting co-administration of both vaccines.
CHILDREN ADMITTED TO HOSPITAL WITH LOWER-CHEST-WALL INDRAWING PNEUMONIA IN SEVEN LOW AND MIDDLE-INCOME COUNTRIES: WHO DIED AND WHO SURVIVED? (ID 758)
- Katherine E. Gallagher, United Kingdom
- Juliet O. Awori, Kenya
- Maria D. Knoll, United States of America
- Chrissy Prosperi, United States of America
- Henry C. Baggett, United States of America
- W. A. Brooks, United States of America
- Daniel R. Feiken, United States of America
- Laura L. Hammitt, United States of America
- Stephen Howie, Gambia
- Karen L. Kotloff, United States of America
- Orin S. Levine, United States of America
- Shabir A. Madhi, South Africa
- David Murdoch, New Zealand
- Katherine L. O'Brien, United States of America
- Donald M. Thea, United States of America
- Vicky L. Baillie, South Africa
- Bernard E. Ebruke, Gambia
- Doli Goswami, Bangladesh
- Alice Kamau, Kenya
- David P. Moore, South Africa
- Lawrence Mwananyanda, United States of America
- Emmanuel O. Olutunde, Gambia
- Phil Seidenberg, United States of America
- Seydou Sissoko, Mali
- Mamadou Sylla, Mali
- Somsak Thamthitiwat, Thailand
- Khalequ Zaman, Bangladesh
- J.A.G Scott, Kenya
Abstract
Background
In 2013, to increase effective distribution of antibiotics, WHO revised treatment guidelines for childhood pneumonia with lower chest wall indrawing (LCWI) to recommend home-based-treatment with oral antibiotics rather than hospital-based management. We analysed the implications of this policy in the PERCH study, where all children were hospitalised.
Methods
In PERCH, 2113 children aged 2-59 months were admitted with LCWI pneumonia between 2011-2014 in Kenya, Zambia, South Africa, Mali, The Gambia, Bangladesh and Thailand. We analysed their mortality risk, and risk factors for mortality using logistic regression.
Results
Among cases with LCWI pneumonia, 76 (3.6%) died in hospital or within 7 days of discharge. Factors associated with fatal outcome included age (aOR 2.03 (95%CI 1.05-3.93) for infants vs older children), absence of cough, oxygen saturation (80-91% oxygen aOR 2.04 (1.07-3.90), <80% aOR 6.51 (2.82-15.0)), low anthropometric scores and HIV exposure.
Conclusions
Despite hospital admission, 3.6% of children with LCWI pneumonia died; mortality may be higher among similar children if treated in the community. Among children with LCWI pneumonia presenting to hospital, selective admission for those who also have hypoxia, features of malnutrition and young age may ensure that those with the greatest risk of death receive optimal supportive therapy.
CHANGES IN ANTIMICROBIAL SUSCEPTIBILITY OF STREPTOCOCCUS PNEUMONIAE 1999-2019 AT A NORTHEAST OHIO ACADEMIC MEDICAL CENTER FOLLOWING INTRODUCTION OF 7- AND 13-VALENT CONJUGATE PNEUMOCOCCAL VACCINES (ID 1048)
Abstract
Background
Antimicrobial resistance has presented a major clinical challenge, with many resistant serotypes included in 7- and 13-valent conjugated vaccines (PCV7, PCV13, Prevnar, Pfizer) introduced in 200 and 2010, respectively.
Methods
This study compares antimicrobial susceptibility of key antimicrobials against pneumococcal isolates from all sources from the year prior to PCV7 introduction (1999), the period following use of PCV7 (2000-2009), the year of PCV13 introduction (2010), and the period since introduction of PCV13 (2011-2019).
Results
2,336 S. pneumoniae were isolated, 196 in 1999, 1,369 in 2000-2009, 68 in 2010 and 708 in 2011-2019 (Table). Over the study period, susceptibility increased for penicillin IV (52.0% to 66.2% at meningitis and 81.6% to 93.1% at nonmeningitis breakpoints), amoxicillin (71.9% to 93.5%), ceftriaxone IV (72.4% to 87.5% at meningitis and 93.9% to 98.1% at nonmeningitis breakpoints) and trimethoprim-sulfamethoxazole (54.6% to 79.6%), and decreased for clindamycin (94.9% to 86.1%). Azithromycin susceptibility initially decreased from 69.4% in 1999 to 47.9% in 2010, and then increased to 60.2% in 2017-2019. Levofloxacin susceptibility was high throughout.
Conclusions
Antimicrobial susceptibility of pneumococci to penicillin, amoxicillin, ceftriaxone and trimethoprim-sulfamethoxazole improved after introduction of conjugate vaccines, while susceptibility to azithromycin and clindamycin did not, with almost 40% of isolates resistant to azithromycin in 2017-2019.