Eloise Price,
Author Of 2 Presentations
THE EFFECT OF ANTIBIOTIC USE ON NASOPHARYNGEAL CARRIAGE OF S. PNEUMONIAE IN A SURVEILLANCE STUDY OF HOSPITALISED CHILDHOOD PNEUMONIA AND MALNUTRITION IN DILI, TIMOR-LESTE (ID 1029)
Abstract
Background
Hospital-based surveillance of pneumonia is an emerging method for monitoring pneumococcal conjugate vaccine (PCV) effectiveness, especially in low resource settings like Timor-Leste. We assessed the impact of antibiotic use on nasopharyngeal carriage of S. pneumoniae (SPN).
Methods
Pulmaun Saudavel is an ongoing pre-PCV surveillance study of children 1-59 months hospitalised with pneumonia and/or malnutrition. Nasopharyngeal swabs were collected as soon as practical after admission and cultured. Antibiotic exposure was classified as prehospital (by parent report) and in-hospital (from the medical record).
Results
Of 160 cases enrolled between September 2019 and January 2020, 43 (26%) had NP carriage of SPN. Carriage was higher among cases without any antibiotic exposure (15/27, 56%), compared to those with any antibiotic exposure (28/133, 21%; p<0.01). While there was no difference in carriage between those with and without prehospital exposure (24% vs 30%, p=0.39), those with swab collected <12hrs after in-hospital exposure had higher carriage compared to those with swab collected >12hrs (50% vs 19%, p=0.034). This remained significant in a logistic regression adjusted for age and sex (p=0.047).
Conclusions
Antibiotic exposure is associated with reduced NP carriage of SPN. Hospital-based studies should attempt to collect NP swabs within 12 hours of first antibiotic dose.
CLINICAL FEATURES OF PNEUMONIA IN CHILDREN WITH AND WITHOUT SEVERE ACUTE MALNUTRITION (SAM): PRELIMINARY FINDINGS FROM A SURVEILLANCE PROJECT AT THE DILI NATIONAL HOSPITAL, TIMOR-LESTE (ID 679)
Abstract
Background
SAM is a significant risk factor for pneumonia, but pneumonia can be hard to diagnose in children with SAM. We aimed to assess differences in clinical findings of pneumonia cases with and without SAM.
Methods
Pulmaun Saudavel is an ongoing surveillance study of children aged 1-59 months hospitalised with pneumonia and/or SAM in Dili, Timor-Leste. Pneumonia was defined as cough or difficulty breathing and any one of: respiratory rate >50bpm, oxygen saturation <90%, lower chest wall indrawing (LCWI), or World Health Organization(WHO)-defined radiological pneumonia. SAM was defined according to WHO criteria.
Results
Of 160 children enrolled between September 2019 and January 2020, 103 (64%) had pneumonia, 27 (17%) SAM, and 30 (19%) both pneumonia and SAM. Two children died, both with pneumonia and SAM. Compared to pneumonia-only cases, children with pneumonia and SAM more frequently met enrolment criteria because of radiological pneumonia (54% vs 42%) and less frequently for LCWI (48% vs 62%), and had more lethargy (43% vs 25%), and vomiting (17% vs 8%; all p>0.05). No differences were found for tachypnoea, hypoxemia, or auscultation findings.
Conclusions
Pneumonia is common in SAM. While LCWI is used in many pneumonia guidelines, it may not be as useful for children with SAM.