German Camacho Moreno, Colombia

Universidad Nacional de Colombia Pediatrics

Poster Author Of 6 e-Posters

Presenter Of 1 Presentation

CLINICAL AND MICROBIOLOGICAL CHARACTERIZATION OF INVASIVE PNEUMOCOCCAL PNEUMONIA IN ADULT PATIENTS IN FIVE HEALTHCARE INSTITUTIONS OF BOGOTA, COLOMBIA (ID 742)

Abstract

Background

Invasive pneumococcal pneumonia (IPP) is a growing health problem, yet data is scarce on the burden of disease in adults. This study describes the clinical and microbiological characteristics of IPP among adults in Colombia.

Methods

A descriptive, observational and retrospective chart review study was conducted in 5 tertiary hospitals in Bogotá, Colombia(2011-2017). Adults ≥18y with IPP defined as pneumonia with pneumococcus isolation in blood/pleural fluid were included. Data on demographics, clinical characteristics, serotypes, and antibiotic susceptibility were collected.

Results

108 IPP cases were identified. The median age was 59y and 55.6% were male. The most frequent comorbidities were: cardiovascular disease(32.4%), chronic pulmonary disease (29%), and malignant neoplasm(23.1%). The most frequent x-ray findings were: lobar consolidation(21.3%), multilobar consolidation(15.5%) and lobar consolidation with pleural effusion(13%). 53.7% of patients required ICU, 52.8% mechanical ventilation and 52.8% inotropics. Case-fatality rate was 37%. The most frequent serotypes were: 3(9.3%), 14(8.3%), 19A(5.6%) and 6C(3.7%). The susceptibility to penicillin was 87.5% and to ceftriaxone 91.7%.

Conclusions

IPP was associated with a substantial ICU admission and lethality. Over one-third of IPP patients had comorbidities. Serotypes not included in the childhood pneumococcal immunization program predominated. It is essential to continue monitoring serotypes to guide vaccine recommendations in Colombia.

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Author Of 7 Presentations

MORTALITY ASSOCIATED WITH INVASIVE PNEUMOCOCCAL DISEASE IN A COLOMBIAN PEDIATRIC POPULATION (2008-2019) (ID 279)

Abstract

Background

Invasive Pneumococcal Disease(IPD) causes high mortality in children under 5 years. Colombia started administering PCV10 in 2012. Neumocolombia network monitors IPD in pediatric patients throughout the country.

Methods

Case series study in 69 deceased pediatric patients with IPD admitted to 10 hospitals of Bogotá in 2008-2019, and 4 hospitals of Cali, 2 of Medellín and 1 of Cartagena in 2017-2019(preliminary data).

Results

The average age of sample was 31 months (0-180 months); 57(82%) were younger than 48 months. The average hospital stay was 7.8 days; 59(85.5%) were admitted to the ICU. 39 cases (56%) presented pneumonia, 14(20%) bacteremia, 13(18.8%) meningitis and 3(4.3%) pneumonia plus meningitis. Case fatality rate was 9%(39/429) for pneumonia, 20%(13/65) for meningitis, 10.9%(14/128) for bacteremia, and 37.5%(3/8) for meningitis plus pneumonia. 41 isolates(59%) were serotyped, and the ones with the highest case fatality rate were serotype 3 with 11.6%(5/43), serotype 14 with 10.7%(7/65), and serotype 19A with 8.9%(10/112). 14 cases(20%) had decreased susceptibility to penicillin.

Conclusions

Mortality from IPD is higher in children under two years. The highest lethality was found in patients with meningitis plus pneumonia, and the most lethal serotype was 3.Permanent monitoring of mortality by IPD after the implementation of mass vaccination with PCV10 is necessary.

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FREQUENCY, CLINICAL AND MICROBIOLOGICAL CHARACTERISTICS, AND OUTCOMES OF PRIMARY BACTEREMIA BY STREPTOCOCCUS PNEUMONIAE IN CHILDREN TREATED AT COLOMBIAN TERTIARY CARE CENTERS 2017 - 2019 (ID 280)

Abstract

Background

Invasive pneumococcal disease is a common cause of morbidity and mortality among children, with a case fatality rate of about 8% in children under 5 years. The frequency of primary bacteremia is 20% of the IPD in children under 2 years.

Methods

Observational, descriptive, longitudinal study. Data were obtained from 40 medical records of patients under 18 years diagnosed with bacteremia by pneumococcus and treated in Neumocolombia network hospitals in 2017-2019. A univariate analysis was performed using frequency and bivariate tables with non-parametric Kruskal-Wallis.

Results

60% of the patients were male. Median age was 24 months (IQR 10 - 48). 52% of the patients were under the age of 2; lethality was 10% and immunization with PCV was 10 50%. The most frequent serotype was 19A, followed by 23B, and 25A(20%, 7.5% and 5.0%, respectively). Resistance to erythromycin was 37.5%, to clindamycin 32.5%, penicillin 22.5% and ceftriaxone 15%. 30% of the children were admitted to the ICU. The average hospital stay was 11 days, and 2.5 days in the ICU.

Conclusions

Primary bacteremia by S. pneumoniae in Colombia has a 10% case fatality rate in children under 2 years, the most frequent serotype being 19A. Penicillin resistance was found in 22.5%.

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CLINICAL, EPIDEMIOLOGICAL AND MICROBIOLOGICAL CHARACTERIZATION OF MENINGITIS BY STREPTOCOCCUS PNEUMONIAE IN A PEDIATRIC POPULATION OF COLOMBIA AFTER MASS VACCINATION WITH PCV10 (ID 274)

Abstract

Background

Acute bacterial meningitis caused by Streptococcus pneumoniae is an important pathology for public health because of its high morbidity and mortality. In 2012, Colombia introduced the vaccine in the compulsory vaccination scheme.

Methods

Ambispective case series study conducted in pediatric patients with meningitis admitted to 10 hospitals of Bogotá (2008-2019), and 4 hospitals of Cali, 2 of Medellín, and 1 of Cartagena (2017-2019). Objective:To perform a clinical, epidemiological and microbiological characterization of patients with meningitis caused by Streptococcus pneumoniae in Colombia from 2008 to 2019, in the hospitals included in Neumocolombia network.

Results

58 cases were related to the pathology. The most frequent symptoms in the cohort were fever, hyporexia and somnolence. Epileptic seizures were particularly common between 4 and 12 months of age. Increased resistance to penicillin and third generation cephalosporins was found in the period 2015-2019. The mortality rate was 20.68%, and the most important sequel was cognitive dysfunction, with a frequency of 73.77%, followed by sensorineural hearing loss, motor disorders and epilepsy. Mortality was associated with low blood cell counts and high C-reactive protein, while age was associated with increased complications and sequelae.

Conclusions

Recent immunization schemes have changed the clinical, microbiological and epidemiological characteristics of pneumococcal meningitis in Colombia.

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CLINICAL OUTCOMES IN ADULTS WITH INVASIVE PNEUMOCOCCAL DISEASE IN FIVE HEALTHCARE INSTITUTIONS OF BOGOTA, COLOMBIA (ID 724)

Abstract

Background

Although invasive pneumococcal disease(IPD) in adults is associated with significant morbidity and mortality, data are yet scarce in low- and middle-income countries. We aimed to characterize clinical outcomes of adults ≥18 years with IPD in Colombia

Methods

A descriptive, observational, and retrospective chart review study was conducted in 5 tertiary hospitals in Bogotá(Colombia) in adults ≥18y with IPD between 2011-2017. Data on demographics, clinical characteristics and serotypes were collected. The main variables analyzed were clinical presentation, length of stay(LOS), UCI admission, case-fatality rate(CFR) and serotype(ST) distribution.

Results

169 cases were included, 48.5%were female and the median age was 58y(IQR:45–70). The main clinical presentation was bacteremic pneumonia (63.3%), followed by bacteremia (19.5%), meningitis (13.6%) and others (3.1%). The median LOS was 12days(IQR:4-20), 58.6% were admitted to UCI(median 5days(IQR:2–13.3)). 53.3% required mechanical ventilation and 50.9% inotropic support. Among 114 cases which had serotyping data, most frequent ST were: 3(11.4%), 14(9.6%), 19A(8.8%), 6C(6.1%), and 6A(5.3%). Table 1 shows CFR per age group, clinical presentation, and main ST.

tabla 1. case-fatality rate in adults with invasive pneumococcal disease in five healthcare.png

Conclusions

IPD was associated with high mortality and UCI admission. Although most cases of deaths were due to pneumonia, higher CFR were seen in adults ≥60y, in bacteremia/meningitis presentations, and ST 3 and 6C.

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RESISTANCE OF STREPTOCOCCUS PNEUMONIAE ISOLATES CAUSING INVASIVE PNEUMOCOCCAL DISEASE IN 17 HOSPITALS OF COLOMBIA. (ID 277)

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.

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CLINICAL AND MICROBIOLOGICAL CHARACTERIZATION OF INVASIVE PNEUMOCOCCAL PNEUMONIA IN ADULT PATIENTS IN FIVE HEALTHCARE INSTITUTIONS OF BOGOTA, COLOMBIA (ID 742)

Abstract

Background

Invasive pneumococcal pneumonia (IPP) is a growing health problem, yet data is scarce on the burden of disease in adults. This study describes the clinical and microbiological characteristics of IPP among adults in Colombia.

Methods

A descriptive, observational and retrospective chart review study was conducted in 5 tertiary hospitals in Bogotá, Colombia(2011-2017). Adults ≥18y with IPP defined as pneumonia with pneumococcus isolation in blood/pleural fluid were included. Data on demographics, clinical characteristics, serotypes, and antibiotic susceptibility were collected.

Results

108 IPP cases were identified. The median age was 59y and 55.6% were male. The most frequent comorbidities were: cardiovascular disease(32.4%), chronic pulmonary disease (29%), and malignant neoplasm(23.1%). The most frequent x-ray findings were: lobar consolidation(21.3%), multilobar consolidation(15.5%) and lobar consolidation with pleural effusion(13%). 53.7% of patients required ICU, 52.8% mechanical ventilation and 52.8% inotropics. Case-fatality rate was 37%. The most frequent serotypes were: 3(9.3%), 14(8.3%), 19A(5.6%) and 6C(3.7%). The susceptibility to penicillin was 87.5% and to ceftriaxone 91.7%.

Conclusions

IPP was associated with a substantial ICU admission and lethality. Over one-third of IPP patients had comorbidities. Serotypes not included in the childhood pneumococcal immunization program predominated. It is essential to continue monitoring serotypes to guide vaccine recommendations in Colombia.

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CHANGES IN SEROTYPE DISTRIBUTION OF INVASIVE PNEUMOCOCCAL DISEASE IN COLOMBIA AFTER MASS VACCINATION WITH PCV10 (ID 278)

Abstract

Background

Invasive Pneumococcal Disease(IPD) causes high morbidity and mortality in children under 5 years. Colombia implemented PCV10 in 2012, and Neumocolombia network monitors IPD in pediatric patients throughout the country.

Methods

Ambispective case series study conducted in pediatric patients with IPD admitted to 10 hospitals of Bogotá (2008-2019), and 4 hospitals of Cali, 2 of Medellín, and 1 of Cartagena (2017-2019). Preliminary data on serotype(Spn) and resistance were obtained.

Results

651 patients were included. Serotyping was obtained in 417(64%); the most frequent serotypes were 19A(26.8%), 14(15.5%), 3(10.3%); and 1(10%). IPD prevalence in serotype 14 decreased from 35.3% (41/116) in 2008-2011 to 6.4% (6/93) in 2012-2014 and to 8.9% (18/202) in 2015-2019. Serotype 1 prevalence decreased from 18.12% (21/116) in 2008-2011, to 19.3%(18/93) in 2012-2014 and to 1.4%(3/202) in 2015-2019. Spn19A increased from 4.3%(5/116) in 2008-2011 to 10.7%(10/93) in 2012-2014 and to 56%(112/202) in 2015-2019. Spn3 increased from 3.4%(4/116) in 2008-2011 to 11.8%(11/93) in 2012-2014, and to 13.8%(28/202) in 2015-2019.

Conclusions

The prevalence of serotypes 14 and 1, included in PCV10, decreased, while serotypes 19A and 3 increased. These findings are relevant for IPD epidemiology, and, according to the WHO, they should promote a change in the immunization schedule with a vaccine against these serotypes.

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