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Camacho-Moreno G, Leal AL, Patiño-Niño J, Vasquez-Hoyos P, Gutiérrez I, Beltrán S, Álvarez-Olmos MI, Mariño AC, Londoño-Ruiz JP, Barrero R, Rojas JP, Espinosa F, Arango-Ferreira C, Suarez MA, Trujillo M, López-Medina E, López P, Coronell W, Ramos N, Restrepo A, Montañez A, Moreno VM. Serotype distribution, clinical characteristics, and antimicrobial resistance of pediatric invasive pneumococcal disease in Colombia during PCV10 mass vaccination (2017-2022). Front Med (Lausanne) 2024; 11:1380125. [PMID: 38841583 PMCID: PMC11150640 DOI: 10.3389/fmed.2024.1380125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/08/2024] [Indexed: 06/07/2024] Open
Abstract
Introduction Invasive Pneumococcal Disease (IPD) causes significant morbidity and mortality in children under 5 y. Colombia introduced PCV10 vaccination in 2012, and the Neumocolombia network has been monitoring IPD in pediatric patients since 2008. Materials and methods This study is a secondary analysis of a prospective cohort involving pediatric patients with IPD admitted to 17 hospitals in Colombia, from January 1st, 2017, to December 31st, 2022. We present data on serotypes (Spn), clinical characteristics, and resistance patterns. Results We report 530 patients, 215 (40.5%) were younger than 24 months. Among these, 344 cases (64.7%) presented with pneumonia, 95 (17.9%) with primary bacteremia, 53 (10%) with meningitis, 6 (1.1%) had pneumonia and meningitis, and 32 (6%) had other IPD diagnosis. The median hospital stay was 12 days (RIQ 8-14 days), and 268 (50.6%) were admitted to the ICU, of whom 60 (11.3%) died. Serotyping was performed in 298 (56.1%). The most frequent serotypes were Spn19A (51.3%), Spn6C (7.7%), Spn3 (6.7%), Spn6A (3.6%), and Spn14 (3.6%). Of 495 (93%) isolates with known susceptibility, 46 (9.2%) were meningeal (M) and 449 (90.7%) non-meningeal (NM). Among M isolates, 41.3% showed resistance to penicillin, and 21.7% decreased susceptibility to ceftriaxone. For NM isolates, 28.2% had decreased susceptibility to penicilin, and 24.2% decreased susceptibility to ceftriaxone. Spn19A showed the highest resistant to penicillin at 47% and was linked to multiresistance. Conclusion The prevalence of PCV10-included serotypes decreased, while serotypes 19A and 6C increased, with Spn19A being associated with multiresistance. These findings had played a crucial role in the decision made by Colombia to modify its immunization schedule by switching to PCV13 in July 2022.
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Affiliation(s)
- Germán Camacho-Moreno
- Red Neumocolombia, Bogotá, Colombia
- Universidad Nacional de Colombia, Bogotá, Colombia
- HOMI, Fundación Hospital Pediatrico de la Misericordia, Bogotá, Colombia
- Hospital Infantil Universitario de San José, Bogotá, Colombia
| | - Aura Lucia Leal
- Red Neumocolombia, Bogotá, Colombia
- Universidad Nacional de Colombia, Bogotá, Colombia
- Grupo Para el Control de la Resistencia Bacteriana en Bogotá, GREBO, Bogotá, Colombia
| | - Jaime Patiño-Niño
- Red Neumocolombia, Bogotá, Colombia
- Fundación Valle del Lili, Cali, Colombia
| | - Pablo Vasquez-Hoyos
- Red Neumocolombia, Bogotá, Colombia
- Universidad Nacional de Colombia, Bogotá, Colombia
| | - Ivan Gutiérrez
- Red Neumocolombia, Bogotá, Colombia
- Clínica Infantil Colsubsidio, Bogotá, Colombia
- Clinicas Colsanitas—Clinica Santa Maria del Lago, Bogotá, Colombia
| | - Sandra Beltrán
- Red Neumocolombia, Bogotá, Colombia
- Clínicas Colsanitas—Clínica Reina Sofia pediátrica y Mujer, Bogotá, Colombia
| | - Martha I. Álvarez-Olmos
- Red Neumocolombia, Bogotá, Colombia
- Fundación Cardioinfantil—Instituto de Cardiología, Bogotá, Colombia
| | - Ana-Cristina Mariño
- Red Neumocolombia, Bogotá, Colombia
- Hospital Militar Central, Bogotá, Colombia
| | | | - Rocio Barrero
- Red Neumocolombia, Bogotá, Colombia
- Hospital Universitario Clínica San Rafael, Bogotá, Colombia
- Unidad de Servicios de Salud Santa Clara, Subred Centro Oriente, Bogotá, Colombia
| | - Juan Pablo Rojas
- Red Neumocolombia, Bogotá, Colombia
- Fundación Clínica Infantil Club Noel, Cali, Colombia
- Universidad Libre Seccional Cali, Cali, Colombia
- Universidad del Valle, Cali, Colombia
| | - Fabio Espinosa
- Red Neumocolombia, Bogotá, Colombia
- Universidad del Valle, Cali, Colombia
| | - Catalina Arango-Ferreira
- Red Neumocolombia, Bogotá, Colombia
- Hospital Universitario San Vicente Fundación, Medellín, Colombia
| | - María Alejandra Suarez
- Red Neumocolombia, Bogotá, Colombia
- Unidad de Servicio de Salud Tunal, Bogotá, Colombia
- Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Monica Trujillo
- Red Neumocolombia, Bogotá, Colombia
- Hospital Pablo Tobón Uribe, Medellín, Colombia
| | - Eduardo López-Medina
- Red Neumocolombia, Bogotá, Colombia
- Universidad del Valle, Cali, Colombia
- Centro Médico Imbanaco, Cali, Colombia
| | - Pio López
- Red Neumocolombia, Bogotá, Colombia
- Universidad del Valle, Cali, Colombia
- Hospital Universitario del Valle, Cali, Colombia
| | - Wilfrido Coronell
- Red Neumocolombia, Bogotá, Colombia
- Hospital Infantil Napoleón Franco Pareja, Cartagena, Colombia
| | - Nicolas Ramos
- Red Neumocolombia, Bogotá, Colombia
- Clínica el Bosque—Los Cobos Medical Center, Bogotá, Colombia
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Gutiérrez-Tobar IF, Londoño-Ruiz JP, Mariño-Drews C, Beltrán-Higuera S, Camacho-Moreno G, Leal-Castro AL, Patiño-Niño JA, Álvarez-Olmos MI, Barrero-Barreto R, Espinosa F, Suarez MA, Ramos N, Moreno-Mejia VM, Marín A, Sierra Parada CR, Pescador A, Montañez A. Epidemiological characteristics and serotype distribution of culture-confirmed pediatric pneumococcal pneumonia before and after PCV 10 introduction, a multicenter study in Bogota, Colombia, 2008-2019. Vaccine 2022; 40:2875-2883. [PMID: 35396166 DOI: 10.1016/j.vaccine.2022.03.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 02/21/2022] [Accepted: 03/10/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pneumococcal conjugate vaccines (PCVs) have decreased pneumonia in children. Colombia introduced mass vaccination with PCV10 in 2012. METHODS Cases of pneumococcal pneumonia from 10 hospitals were included. Two periods were compared: pre-PCV10: 2008-2011 and post-PCV10: 2014-2019. The objective was to compare epidemiological and clinical characteristics before and after PCV10 vaccination. RESULTS A total of 370 cases were included. Serotypes 1 (15, 11.2%) and 14 (33, 24.6%) were the most frequent in the pre-PCV10 period, with only 4 (3%) cases of serotype 19A and 1 case (0.7%) serotype 3. From the pre-PCV10 period to the post-PCV10 period, cases of serotypes 1 (6, 3.1%) and 14 (1, 7.8%) decreased, while cases of serotypes 19A (58, 30.2%), serotype 3 (32, 16.7%) and 6A (7, 3.6%) increased (p < 0.001); complicated pneumonia (CP) increased significantly (13.4% to 31.8%) (p < 0.001); hospitalizations increased from 8 (5.5-15) to 12 (7-22) days (p < 0.001); and the frequency of PICU admission increased from 32.8% to 51.6% (p = 0.001). The use of ampicillin-sulbactam (0.7% to 24%) and ceftriaxone/clindamycin (0.7% to 5.7%) increased in the post-PCV10 period. The duration of empirical antibiotic treatment was 7 (4-11) days in the pre-PCV10 period and increased to 10 (6-17) days (p < 0.001) in the post-PCV10 period. Lethality showed a slight nonsignificant increase (7.5% vs. 9.9%; p = 0.57) in the post-PCV10 period. CONCLUSIONS PCV10 significantly decreased cases of serotypes 1 and 14, with an increase in cases of serotypes 19A, 3 and 6A, which were the predominant serotypes and had greater severity (e.g., admission to the PICU, CP and more resistance, with an increase in the use of broad-spectrum antibiotics and longer hospitalization) and subsequently included in PCV13. Current data support national and regional evidence on the importance of replacing PCV10 with a higher valence that includes 19A, such as PCV13, with the aim of reducing circulation, particularly of this serotype.
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Affiliation(s)
| | - Juan Pablo Londoño-Ruiz
- Red Neumocolombia, Colombia; Clínica Infantil Colsubsidio, Clínica Infantil Santa María del Lago, Colombia; Universidad el Bosque, Colombia
| | | | | | - Germán Camacho-Moreno
- Red Neumocolombia, Colombia; HOMI, Fundación Hospital Pediátrico la Misericordia, Bogotá, Colombia; Hospital Infantil Universitario de San José, Colombia; Universidad Nacional de Colombia.
| | | | | | | | - Rocio Barrero-Barreto
- Red Neumocolombia, Colombia; Hospital Universitario Clínica San Rafael, Colombia; Unidad de Servicios de Salud Santa Clara, Colombia
| | - Fabio Espinosa
- Red Neumocolombia, Colombia; Hospital Infantil Universitario de San José, Colombia
| | | | - Nicolás Ramos
- Red Neumocolombia, Colombia; COBOS Medical Center, Colombia; Universidad el Bosque, Colombia
| | | | - Alejandra Marín
- Red Neumocolombia, Colombia; Clínica Infantil Colsubsidio, Clínica Infantil Santa María del Lago, Colombia
| | | | - Angela Pescador
- Red Neumocolombia, Colombia; Hospital Militar Central, Colombia
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