Perfil clínico y microbiológico de bacteremia primaria por Streptococcus pneumoniae en pacientes pediatricos hospitalizados a la red de atención terciaria Neumocolombia. 2017 – 2019
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Objetivo: Describir las características clínicas, microbiológicas y los desenlaces de las bacteriemias primarias por S. pneumoniae ocurridas en población pediátrica hospitalizada en instituciones de alta complejidad, pertenecientes a la Red Neumocolombia (2017-2019). Metodología: Estudio observacional, descriptivo, longitudinal, exploratorio con alcance analítico, en donde se tomó información de las historias clínicas con hemocultivos positivos para S. pneumoniae sin otro foco infeccioso, realizados en los hospitales pediátricos, reportados a la Red Neumocolombia (2017-2019). Resultados: Durante el periodo de estudio se analizó información de 51 registros, 62,7% fueron hombres, la mediana de edad fue 25 meses (RIC 9-49). El síntoma predominante fue fiebre (78,4%), se reportó vacunación con Vacuna Neumocócica Conjugada decavalente (PCV-10) en 47%. El serotipo más frecuente fue 19A (39,4%). El porcentaje de resistencia antibiótica fue: eritromicina 43%, penicilina 25.4%, cefotaxima 11,7%. Los factores relacionados al ingreso a Unidades de Cuidado Intensivo Pediátrico (UCIP) fueron: dolor pleurítico (OR27,9; IC95%3,13 – 248,16 p=0,03), tos (OR6,04; IC95%1,46 – 24,88; p=0,013), dolor abdominal (OR 6,5; IC95%1,85 – 22,80; p=0,003), dificultad respiratoria (OR12; IC95%2,95 – 48,77 p=0,001), tirajes (OR22,71; IC95%4,65 – 141,90 p=0,001), cianosis (OR8,69; IC95%1,95 – 38,65 p=0,004), hipotermia (OR42,62; IC95%4,77 – 380,74 p=0,001), serotipo 19A (OR3,9;IC95%1,10 – 13,81 p=0,035). La letalidad fue del 11,7%. Conclusión: Después de la introducción de la vacuna PCV10 en Colombia en el año 2012 se reportaron cambios en la epidemiologia, con disminución de los serotipos vacunales, y aumento en el serotipo 19A, siendo uno de los factores que intervienen en el ingreso a UCIP por bacteriemia primaria. Se reporta aumento en la resistencia por eritromicina, penicilina y cefotaxima.
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Leibovitz E, David N, Ribitzky-Eisner H, Madegam MA, Abuabed S, Chodick G, et al. The Epidemiologic, Microbiologic and Clinical Picture of Bacteremia among Febrile Infants and Young Children Managed as Outpatients at the Emergency Room, before and after Initiation of the Routine Anti-Pneumococcal Immunization. 2016 [cited 2019 Jun 18]; Available from: www.mdpi.com/journal/ijerph
https://doi.org/10.3390/ijerph13070723
Lynch J, Zhanel G. Streptococcus pneumoniae: Epidemiology, Risk Factors, and Strategies for Prevention. Semin Respir Crit Care Med [Internet]. 2009 Apr 18 [cited 2019 Jun 17];30(02):189-209. Available from: http://www. ncbi.nlm.nih.gov/pubmed/19296419
https://doi.org/10.1055/s-0029-1202938
Rojas JP, Leal AL, Patiño J, Montañez A, Camacho G, Beltrán S, et al. Caracterización de pacientes fallecidos por enfermedad neumocóccica invasiva en la población infantil de Bogotá, Colombia. Rev Chil Pediatr [Internet]. 2016 [cited 2019 Feb 21];87(1):48-52. Available from: www.elsevier.es/rchpEXPERIENCIACLÍNICA
https://doi.org/10.1016/j.rchipe.2015.10.005
States M, Group A, Membres E. Weekly epidemiological record Relevé épidémiologique hebdomadaire WORLD HEALTH. world Heal Organ. 2008;(42):373-84.
Díaz Peña R, Espinoza Oliva MM, Lamas Briseño MT. Abordaje del niño con fiebre sin foco infeccioso. Enfermedades Infecc y Microbiol. 2004;24(3):31-8.
Aalst M Van, Lötsch F, Spijker R, Meer JTM Van Der, Langendam MW, Goorhuis A, et al. Incidence of invasive pneumococcal disease in immunocompromised patients : A systematic review and meta-analysis. Travel Med Infect Dis [Internet]. 2018;24(June):89-100. Available from: https://doi.org/10.1016/j.tmaid.2018.05.016
https://doi.org/10.1016/j.tmaid.2018.05.016
Cruickshank HC, Jefferies JM, Clarke SC. Lifestyle risk factors for invasive pneumococcal disease: a systematic review. BMJ Open [Internet]. 2014 [cited 2020 Jul 12];4:5224. Available from: http://dx.doi.org/10.1136/ bmjopen-2014-005224
https://doi.org/10.1136/bmjopen-2014-005224
Angeles M, Rodríguez G, Varela A, Ascensión M, Gavín O, Martín F, et al. Invasive pneumococcal disease : Association between serotype , clinical presentation and lethality. 2013;29(2011):5740-6.
https://doi.org/10.1016/j.vaccine.2011.05.099
Tan TQ. Pediatric Invasive Pneumococcal Disease in the United States in the Era of Pneumococcal Conjugate Vaccines. 2012 [cited 2019 Feb 24]; Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3416489/pdf/zcm409.pdf
https://doi.org/10.1128/CMR.00018-12
Wahl B, Brien KLO, Greenbaum A, Majumder A, Liu L, Chu Y, et al. Articles Burden of Streptococcus pneumoniae and Haemophilus influenzae type b disease in children in the era of conjugate vaccines : global , regional , and national estimates for. 2018;6(July):744-57.
https://doi.org/10.1016/S2214-109X(18)30247-X
Aislamientos A. Vigilancia por laboratorio de S. pneumoniae en Colombia, 2019. 591. 2019;6-8.
Tan TQ. Pediatric invasive pneumococcal disease in the United States in the era of pneumococcal conjugate vaccines [Internet]. Vol. 25, Clinical Microbiology Reviews. American Society for Microbiology (ASM); 2012 [cited 2020 Jul 11]. p. 409-19. Available from: /pmc/articles/ PMC3416489/?report=abstract
https://doi.org/10.1128/CMR.00018-12
Greenhow TL, Hung Y-Y, Herz A. Bacteremia in Children 3 to 36 Months Old After Introduction of Conjugated Pneumococcal Vaccines. Pediatrics. 2017;139(4):e20162098.
https://doi.org/10.1542/peds.2016-2098
Tazeen Fatima1, Faisal Malik1, Erum Khan1, Fatima Mir2 SS. Clinical Features and Outcomes of Pneumococcal Bacteremia among Children at a Tertiary Care Hospital. Biomed Biotechnol Res J 2018;2152-5 [Internet]. 2018; Available from: http://www.bmbtrj.org
Laaksonen N, Rintamäki L, Korppi M. Pneumococcal vaccinations effectively prevent blood culture-negative infections that resemble occult pneumococcal bacteremia or bacteremic pneumococcal pneumonia at one to 36 months of age. Acta Paediatr Int J Paediatr [Internet]. 2016 Dec 1 [cited 2020 Sep 5];105(12):1487-92. Available from: http://doi.wiley. com/10.1111/apa.13580
https://doi.org/10.1111/apa.13580
Wilkinson M, Bulloch B, Smith M. Prevalence of Occult Bacteremia in Children Aged 3 to 36 Months Presenting to the Emergency Department with Fever in the Postpneumococcal Conjugate Vaccine Era. Acad Emerg Med [Internet]. 2009;16:220-5. Available from: www.aemj.org
https://doi.org/10.1111/j.1553-2712.2008.00328.x
Herz AM, Greenhow TL, Alcantara J, Hansen J, Baxter RP, Black SB, et al. Changing epidemiology of outpatient bacteremia in 3- to 36-monthold children after the introduction of the heptavalent-conjugated pneumococcal vaccine. Pediatr Infect Dis J [Internet]. 2006 Apr [cited 2020 Sep 6];25(4):293-300. Available from: http://journals.lww.com/00006454-200604000-00003
https://doi.org/10.1097/01.inf.0000207485.39112.bf
Mintegi S, Benito J, Sanchez J, Azkunaga B, Iturralde I, Garcia S. Predictors of occult bacteremia in young febrile children in the era of heptavalent pneumococcal conjugated vaccine. Eur J Emerg Med [Internet]. 2009 Aug [cited 2020 Sep 6];16(4):199-205. Available from: http://journals.lww. com/00063110-200908000-00008
https://doi.org/10.1097/MEJ.0b013e32831cefc9
Stoll ML, Rubin LG. Incidence of Occult Bacteremia Among Highly Febrile Young Children in the Era of the Pneumococcal Conjugate Vaccine. Arch Pediatr Adolesc Med [Internet]. 2004 Jul 1 [cited 2019 Jun 10];158(7):671. Available from: http://archpedi.jamanetwork.com/article.aspx?doi=10.1001/archpedi.158.7.671
https://doi.org/10.1001/archpedi.158.7.671
Sard B, Bailey MC, Vinci R. An Analysis of Pediatric Blood Cultures in the Postpneumococcal Conjugate Vaccine Era in a Community Hospital Emergency Department. Pediatr Emerg Care [Internet]. 2006 May [cited 2019 May 5];22(5):295-300. Available from: https://insights.ovid.com/crossref?an=00006565-200605000-00001
https://doi.org/10.1097/01.pec.0000215137.51909.16
Pilishvili T, Zell ER, Farley MM, Schaffner W, Lynfield R, Nyquist AC, et al. Risk factors for invasive pneumococcal disease in children in the era of conjugate vaccine use. Pediatrics [Internet]. 2010 Jul 1 [cited 2020 Sep 2];126(1):e9-17. Available from: https://pediatrics.aappublications.org/content/126/1/e9
https://doi.org/10.1542/peds.2009-2150
Moore MR, Link-Gelles R, Schaffner W, Lynfield R, Lexau C, Bennett NM, et al. Impact of 13-Valent Pneumococcal Conjugate Vaccine Used in Children on Invasive Pneumococcal Disease in Children and Adults in the United States: Analysis of Multisite, Population-based Surveillance HHS Public Access. Lancet Infect Dis [Internet]. 2015 [cited 2020 Jul 7];15(3):301-9. Available from: http://www.cdc.gov/abcs/index.html.
https://doi.org/10.1016/S1473-3099(14)71081-3
Vera CG nstituto A de C de la S. ESTADO DE PORTADOR DE NEUMOCOCO EN NIÑOS Y SU RELACION CON LA ENFERMEDAD INVASIVA. Rev 1 Vera CG nstituto A C la S ESTADO PORTADOR NEUMOCOCO EN NIÑOS Y SU Relac CON LA Enferm INVASIVA Rev Pediatr Aten Primaria 2010;12457-82 2010;Vol XII Pediatr Aten Primaria 2010;12457-82. 2010;Vol. XII.
Weinberger DM, Pitzer VE, Regev-Yochay G, Givon-Lavi N, Dagan R. Association between the Decline in Pneumococcal Disease in Unimmunized Adults and Vaccine-Derived Protection Against Colonization in Toddlers and Preschool-Aged Children. In: American Journal of Epidemiology. Oxford University Press; 2019. p. 160-8.
https://doi.org/10.1093/aje/kwy219
Budnik I, Sandoval A, Prado A, Labbé M, Pena A, Viviani T. Bacteriemia oculta en niños atendidos en el Complejo Asistencial Dr. Sótero del Río: Experiencia post vacuna neumocóccica conjugada. Rev Chil infectología [Internet]. 2017 Apr [cited 2020 Sep 7];34(2):133-40. Available from: http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S071610182017000200006&lng=en&nrm=iso&tlng=en
https://doi.org/10.4067/S0716-10182017000200006
Muñ Oz-Almagro C, Jordan I, Gene A, Latorre C, Garcia-Garcia JJ, Pallares R. Emergence of Invasive Pneumococcal Disease Caused by Nonvaccine Serotypes in the Era of 7-Valent Conjugate Vaccine. Available from: https://academic.oup.com/cid/article/46/2/174/454026
https://doi.org/10.1086/524660
Ecdc. Invasive pneumococcal disease Annual Epidemiological Report for 2017 Key facts.