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Lyu Z, Li J, Zhen J, Shi W, Meng Q, Zhou W, An J, Yao K, Dong F. A Hospital-Based and Cross-Sectional Investigation on Clinical Characteristics of Pediatric Streptococcus pneumoniae Isolates in Beijing from 2015 to 2021. Infect Drug Resist 2023; 16:499-508. [PMID: 36726384 PMCID: PMC9885871 DOI: 10.2147/idr.s398549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/14/2023] [Indexed: 01/26/2023] Open
Abstract
Introduction Streptococcus pneumoniae (S. pneumoniae) is a major pathogen causing death in children. Few studies have evaluated the importance of S. pneumoniae in the identified bacteria in clinical work. This retrospective study aimed to reveal the rank of S. pneumoniae in determined bacteria isolated from children in Beijing, China, as well as the antimicrobial resistance of this pathogen. Methods The number of specimen for bacterial culture and of bacterial species were cumulated and ranked based on the data of the two largest children's hospitals in Beijing from 2015 to 2021. The temporal change of S. pneumoniae culture, as well as the clinical data of S. pneumoniae isolates were collected and analyzed. The minimum inhibitory concentrations of antimicrobial agents were determined by BD Phoenix 100 automated system or Vitek 2 automated system for antimicrobial susceptibility testing. The breakpoints recommended by CLSI were adopted. Results During the 7-year study period, a total of 45,631 bacterial isolates were cultured from 462,144 submitted specimens, in which S. pneumoniae was the third frequent agent following S. aureus and H. influenza, and accounting for 8.79% of the isolates (4011/45,631). In the 4011 S. pneumoniae isolates, 2239 and 997 ones were, respectively, isolated from sputum and bronchial lavage fluid. Most of S. pneumoniae strains were identified in winter (34.7%) and spring (26.1%), and were mainly isolated from patients under 5 years old (77.1%). Low susceptible rate (27.6%) of CSF isolates was determined to penicillin according to the parenteral meningitis breakpoints, while high susceptible rate (56.9%) of non-CSF isolates was obtained according to the parenteral non-meningitis breakpoints. The isolates showed low sensitivity to erythromycin and tetracycline (<5%). All isolates were susceptible to vancomycin and linezolid. Conclusion The present results demonstrated that S. pneumoniae was one of the most commonly detected bacteria in current pediatric clinical tests, especially in young children under 5 years old, which emphasized the importance of prevention. Penicillin could still be the first empiric choice to treat non-meningitis pneumococcal infections, while erythromycin should not be involved in the treatment.
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Affiliation(s)
- Zhiyong Lyu
- Department of Clinical Laboratory Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China
| | - Jing Li
- Department of Clinical Laboratory, Capital Institute of Pediatrics, Beijing, People’s Republic of China
| | - Jinghui Zhen
- Department of Clinical Laboratory Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China
| | - Wei Shi
- Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, National Key Discipline of Pediatrics (Capital Medical University), Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China
| | - Qingying Meng
- Department of Clinical Laboratory Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China
| | - Wei Zhou
- Department of Clinical Laboratory Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China
| | - Jingyun An
- Department of Clinical Laboratory Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China
| | - Kaihu Yao
- Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, National Key Discipline of Pediatrics (Capital Medical University), Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China
| | - Fang Dong
- Department of Clinical Laboratory Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China,Correspondence: Fang Dong; Kaihu Yao, Department of Clinical Laboratory Center, Beijing Children’s Hospital Affiliated to Capital Medical University, No. 56 Nan Lishi Road, Beijing, 100045, People’s Republic of China, Email ;
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Tsai YT, Lee YL, Lu MC, Shao PL, Lu PL, Cheng SH, Ko WC, Lin CY, Wu TS, Yen MY, Wang LS, Liu CP, Lee WS, Shi ZY, Chen YS, Wang FD, Tseng SH, Lin CN, Chen YH, Sheng WH, Lee CM, Tang HJ, Lin CY, Chen YH, Hsueh PR. Nationwide surveillance of antimicrobial resistance in invasive isolates of Streptococcus pneumoniae in Taiwan from 2017 to 2019. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2021; 55:215-224. [PMID: 34219043 DOI: 10.1016/j.jmii.2021.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/27/2021] [Accepted: 05/06/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND/PURPOSE Streptococcus pneumoniae causes pneumonia and other invasive diseases, and is a leading cause of mortality in the elderly population. The present study aimed to provide current antimicrobial resistance and epidemiological profiles of S. pneumoniae infections in Taiwan. METHODS A total of 252 nonduplicate S. pneumoniae isolates were collected from patients admitted to 16 hospitals in Taiwan between January 2017 and December 2019, and were analyzed. The minimum inhibitory concentration of antibiotics was determined using the Vitek 2 automated system for antimicrobial susceptibility testing. Furthermore, epidemiological profiles of S. pneumoniae infections were analyzed. RESULTS Among the strains analyzed, 88% were recognized as invasive pneumococcal strains. According to the Clinical and Laboratory Standards Institute criteria for non-meningitis, the prevalence of penicillin-non-susceptible S. pneumoniae demonstrated a declining trend from 43.6% in 2017 to 17.2% in 2019. However, the rate of penicillin-non-susceptible S. pneumoniae was 85.7% based on the criteria for meningitis. Furthermore, the prevalence of ceftriaxone-non-susceptible S. pneumoniae was 62.7% based on the criteria for meningitis. Isolates demonstrated higher susceptibility toward doripenem and ertapenem than toward meropenem and imipenem. An increased rate of non-susceptibility toward levofloxacin was observed in southern Taiwan (15.1%) and elderly patients (≥65 years; 11.4%). Most isolates were susceptible to vancomycin and linezolid. CONCLUSION Empirical treatment with ceftriaxone monotherapy for pneumococcal meningitis should be carefully monitored owing to its high non-susceptibility rate. The susceptibility rates of most isolates to penicillin (used for treating non-meningitis pneumococcal diseases), carbapenems (ertapenem and doripenem), respiratory quinolones (moxifloxacin and levofloxacin), vancomycin, and linezolid suggested the potential of these antibiotics in treating pneumococcal diseases in Taiwan.
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Affiliation(s)
- Yu-Te Tsai
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine, Graduate Institute of Medicine, Sepsis Research Center, Center of Tropical Medicine and Infectious Diseases, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Lin Lee
- Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan; Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung, Taiwan
| | - Min-Chi Lu
- Department of Microbiology and Immunology, School of Medicine, China Medical University, Taichung, Taiwan
| | - Pei-Lan Shao
- Department of Pediatrics, Hsin-Chu Branch, National Taiwan University Hospital, Hsin-Chu, Taiwan
| | - Po-Liang Lu
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine, Graduate Institute of Medicine, Sepsis Research Center, Center of Tropical Medicine and Infectious Diseases, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shu-Hsing Cheng
- Department of Internal Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan; School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan
| | - Wen-Chien Ko
- Department of Internal Medicine, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan
| | - Chi-Ying Lin
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan
| | - Ting-Shu Wu
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Muh-Yong Yen
- Division of Infectious Diseases, Taipei City Hospital, and National Yang-Ming University, School of Medicine, Taipei, Taiwan
| | - Lih-Shinn Wang
- Division of Infectious Diseases, Department of Internal Medicine, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Chang-Pan Liu
- Division of Infectious Diseases, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan; MacKay Medical College, New Taipei City, Taiwan
| | - Wen-Sen Lee
- Division of Infectious Diseases, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taiwan; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Zhi-Yuan Shi
- Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yao-Shen Chen
- Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Fu-Der Wang
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shu-Hui Tseng
- Center for Disease Control and Prevention, Ministry of Health and Welfare, Taiwan
| | - Chao-Nan Lin
- Department of Veterinary Medicine, College of Veterinary Medicine, National Pingtung University of Science and Technology, Taiwan; Animal Disease Diagnostic Center, College of Veterinary Medicine, National Pingtung University of Science and Technology, Pingtung, Taiwan
| | - Yu-Hui Chen
- Infection Control Center, Chi Mei Hospital, Liouying, Taiwan
| | - Wang-Huei Sheng
- Division of Infectious Diseases, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chun-Ming Lee
- Department of Internal Medicine, St Joseph's Hospital, Yunlin County, Taiwan; MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Hung-Jen Tang
- Department of Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Chun-Yu Lin
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine, Graduate Institute of Medicine, Sepsis Research Center, Center of Tropical Medicine and Infectious Diseases, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yen-Hsu Chen
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine, Graduate Institute of Medicine, Sepsis Research Center, Center of Tropical Medicine and Infectious Diseases, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Biological Science and Technology, College of Biological Science and Technology, National Chiao Tung University, HsinChu, Taiwan; Institute of Medical Science and Technology, National Sun Yat-sen University, Kaohsiung, Taiwan.
| | - Po-Ren Hsueh
- Division of Infectious Diseases, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
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Sharew B, Moges F, Yismaw G, Abebe W, Fentaw S, Vestrheim D, Tessema B. Antimicrobial resistance profile and multidrug resistance patterns of Streptococcus pneumoniae isolates from patients suspected of pneumococcal infections in Ethiopia. Ann Clin Microbiol Antimicrob 2021; 20:26. [PMID: 33879172 PMCID: PMC8059007 DOI: 10.1186/s12941-021-00432-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 04/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background Antimicrobial-resistant strains of Streptococcus pneumoniae have become one of the greatest challenges to global public health today and inappropriate use of antibiotics and high level of antibiotic use is probably the main factor driving the emergence of resistance worldwide. The aim of this study is, therefore, to assess the antimicrobial resistance profiles and multidrug resistance patterns of S. pneumoniae isolates from patients suspected of pneumococcal infections in Ethiopia. Methods A hospital-based prospective study was conducted from January 2018 to December 2019 at Addis Ababa city and Amhara National Region State Referral Hospitals. Antimicrobial resistance tests were performed from isolates of S. pneumoniae that were collected from pediatric and adult patients. Samples (cerebrospinal fluid, blood, sputum, eye discharge, ear discharge, and pleural and peritoneal fluids) from all collection sites were initially cultured on 5% sheep blood agar plates and incubated overnight at 37 °C in a 5% CO2 atmosphere. Streptococcus pneumoniae was identified and confirmed by typical colony morphology, alpha-hemolysis, Gram staining, optochin susceptibility, and bile solubility test. Drug resistance testing was performed using the E-test method according to recommendations of the Clinical and Laboratory Standards Institute. Results Of the 57 isolates, 17.5% were fully resistant to penicillin. The corresponding value for both cefotaxime and ceftriaxone was 1.8%. Resistance rates to erythromycin, clindamycin, tetracycline, chloramphenicol and trimethoprim-sulfamethoxazole were 59.6%, 17.5%, 38.6%, 17.5 and 24.6%, respectively. Multidrug resistance (MDR) was seen in 33.3% isolates. The most common pattern was co-resistance to penicillin, erythromycin, clindamycin, and tetracycline. Conclusions Most S. pneumoniae isolates were susceptible to ceftriaxone and cefotaxime. Penicillin has been used as a drug of choice for treating S. pneumoniae infection. However, antimicrobial resistance including multidrug resistance was observed to several commonly used antibiotics including penicillin. Hence, it is important to periodically monitor the antimicrobial resistance patterns to select empirical treatments for better management of pneumococcal infection.
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Affiliation(s)
- Bekele Sharew
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia. .,Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, P. O. Box 45, Dessie, Ethiopia.
| | - Feleke Moges
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia
| | - Gizachew Yismaw
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia
| | - Wondwossen Abebe
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia
| | - Surafal Fentaw
- Ethiopian Public Health Institute, P. O. Box 641, Addis Ababa, Ethiopia
| | | | - Belay Tessema
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia
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Wu CJ, Lai JF, Huang IW, Shiau YR, Wang HY, Lauderdale TL. Serotype Distribution and Antimicrobial Susceptibility of Streptococcus pneumoniae in Pre- and Post- PCV7/13 Eras, Taiwan, 2002-2018. Front Microbiol 2020; 11:557404. [PMID: 33193140 PMCID: PMC7642986 DOI: 10.3389/fmicb.2020.557404] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 09/29/2020] [Indexed: 01/07/2023] Open
Abstract
In Taiwan, the 7-valent pneumococcal conjugate vaccine (PCV7) was introduced in 2006 and a PCV13 national childhood catchup program was implemented in 2013. To delineate the trend of serotype distribution and antimicrobial susceptibility following vaccination programs, we investigated a total of 1845 Streptococcus pneumoniae isolates collected biennially between 2002 and 2018 over a 3-month period from 25 hospitals. The number of isolates collected over the years decreased significantly in all age groups, from a total of 320 isolates in 2002 (pre-PCV), to 196 in 2010 (post-PCV7/pre-PCV13), to 89 in 2018 (post-PCV13). Overall, PCV7/PCV13 serotypes comprised 66.9%/76.3%, 53.1%/78.1%, and 15.7%/31.5% of isolates in 2002, 2010, and 2018, respectively. The leading serotypes in the pre-PCV era were 23F, 19F, 6B, and 14, while serotype 19A predominated in the post-PCV7/pre-PCV13 era, but non-vaccine serotypes (NVT) 15A (18.0%) and 23A (15.7%) surpassed 19A (10.1%) to become the top two leading serotypes in 2018. All the major serotypes, including the emergent serotypes 15A and 23A, were multidrug-resistant with high rates of non-susceptibility to β-lactam (except serotype 3) and several non-β-lactam agents. PFGE and MLST revealed that while meropenem-susceptible serotype 15A-ST3058 isolates and a serotype 23A-ST338 clone existed in earlier years, rise and spread of meropenem-non-susceptible serotype 15A-ST63 and serotype 23A-ST166 clones occurred in recent years. We conclude that successive implementation of PCVs has led to a marked decrease in pneumococcal isolate burden, but the replacement by meropenem-non-susceptible NVT 15A and 23A highlights the need for continued local surveillance to track pneumococcal evolution in each region to help vaccine polyvalency decisions.
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Affiliation(s)
- Chi-Jung Wu
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan.,Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jui-Fen Lai
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan
| | - I-Wen Huang
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan
| | - Yih-Ru Shiau
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan
| | - Hui-Ying Wang
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan
| | - Tsai-Ling Lauderdale
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan
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Su PY, Huang AH, Lai CH, Lin HF, Lin TM, Ho CH. Extensively drug-resistant Haemophilus influenzae - emergence, epidemiology, risk factors, and regimen. BMC Microbiol 2020; 20:102. [PMID: 32345232 PMCID: PMC7189504 DOI: 10.1186/s12866-020-01785-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 04/07/2020] [Indexed: 02/01/2023] Open
Abstract
Background Concern about Haemophilus influenzae infection has been increasing over recent decades. Given the emergence of H. influenzae with severe drug resistance, we assessed the prevalence of as well as risk factors and potential therapies for extensively drug-resistant (XDR) H. influenzae infection in Taiwan. Results In total, 2091 H. influenzae isolates with disk diffusion-based antibiotic susceptibility testing from 2007 to 2018 were enrolled. H. influenzae strains resistant to ampicillin, chloramphenicol, levofloxacin, and trimethoprim-sulfamethoxazole tended to be isolated from patient wards (≧41%), whereas those resistant to amoxicillin-clavulanate, cefotaxime, and cefuroxime were more likely to be isolated from intensive care units (approximately 50%). XDR H. influenzae was first identified in 2007, and its incidence did not significantly change thereafter. Overall prevalence of single, multiple, and extensively drug-resistant H. influenzae over 2007–2018 was 21.5% (n = 450), 26.6% (n = 557), and 2.5% (n = 52), respectively. A stepwise logistic regression analysis revealed that blood culture (odds ratio: 4.069, 95% confidence intervals: 1.339–12.365, P = 0.013) was an independent risk factor for XDR H. influenzae infection. No nosocomial transmission of XDR H. influenzae observed. Antibiotic susceptibility testing results demonstrated that cefotaxime was effective against 78.8% (n = 41) of the XDR strains. Conclusions The presence of XDR H. influenzae strains was identified in Taiwan, and cefotaxime was efficacious against most of these strains.
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Affiliation(s)
- Pei-Yi Su
- Department of Laboratory Medicine, E-DA Hospital, Kaohsiung, Taiwan
| | - Ay-Huey Huang
- Department of Laboratory Medicine, E-DA Hospital, Kaohsiung, Taiwan
| | - Chung-Hsu Lai
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.,Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Hsiu-Fang Lin
- Department of Laboratory Medicine, E-DA Hospital, Kaohsiung, Taiwan
| | - Tsun-Mei Lin
- Department of Medical Laboratory Science, College of Medicine, I-Shou University, No.8, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung City, 82445, Taiwan
| | - Cheng-Hsun Ho
- Department of Medical Laboratory Science, College of Medicine, I-Shou University, No.8, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung City, 82445, Taiwan.
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The Prevalence of Antimicrobial Resistance and Serotypes of Streptococcus pneumoniae in the Kingdom of Bahrain. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2020. [DOI: 10.22207/jpam.14.1.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Lai YR, Lin JR, Chang WN, Tsai NW, Huang CC, Wang HC, Su YJ, Lin WC, Cheng BC, Su CM, Hsiao SY, Kuo CE, Lu CH. Outcomes of adjunctive steroid therapy in adult patients with bacterial meningitis in Taiwan: A nationwide population-based epidemiologic study. J Clin Neurosci 2018; 61:54-58. [PMID: 30467052 DOI: 10.1016/j.jocn.2018.10.146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 10/29/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Although corticosteroids are an effective anti-inflammatory adjuvant therapy, the role of adjunctive steroid therapy in treating adult bacterial meningitis in Taiwan remains controversial. METHODS Cases of acute bacterial meningitis were identified from the annual hospitalization discharge claims of the National Health Insurance Research Database using International Classification of Diseases, Ninth Revision codes from January 2000 to December 2013. Patients were classified into two groups: (1) steroid group (adjunctive steroids and empirical antibiotics) and (2) placebo group (empirical antibiotics only). RESULTS There were 15,037 patients enrolled in this study; of these, 57% (7175/15,037) and 52% (7862/15,037) were placed in the placebo and steroid groups, respectively. The case-fatality rates were 11.5% (826/7175) in the placebo group and 19.9% (1562/7862) in the steroid groups during hospitalization (P = 0.77). Further, the hazard ratio (relative to placebo group) of in-hospital and one-year case fatality rate were 0.923 (95% confidence interval [CI]: 0.846-1.007, P = 0.073) and 1.514 (95% CI: 1.425-1.608, P < 0.0001) according to the multivariate Cox model after adjustment for age and sex. CONCLUSION On the basis of these results, steroid group had a more fulminant clinical course (e.g., acute respiratory failure and pneumonia, etc.), and unfavorable outcomes than placebo group. Therefore, more prospective, randomized, double-blind trials are warranted to evaluate the efficacy of adjunctive steroid therapy in treating adult bacterial meningitis in Taiwan.
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Affiliation(s)
- Yun-Ru Lai
- Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Jr-Rung Lin
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan Tao-Yuan 333, Taiwan
| | - Wen-Neng Chang
- Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Nai-Wen Tsai
- Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Cheng Huang
- Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hung-Chen Wang
- Department of Neurosurgery, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Jih Su
- Department of Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Che Lin
- Department of Radiology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ben-Chung Cheng
- Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan; Department of Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Min Su
- Department of Emergency Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sheng-Yuan Hsiao
- Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan; Department of Emergency Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chun-En Kuo
- Department of Chinese Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Hsien Lu
- Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan; Department of Center for Shockwave Medicine and Tissue Engineering, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Neurology, Xiamen Chang Gung Memorial Hospital, Xiamen, China.
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Liu EYM, Chang JC, Lin JC, Chang FY, Fung CP. Important Mutations Contributing to High-Level Penicillin Resistance in Taiwan 19F-14, Taiwan 23F-15, and Spain 23F-1 of Streptococcus pneumoniae Isolated from Taiwan. Microb Drug Resist 2016; 22:646-654. [PMID: 27042760 DOI: 10.1089/mdr.2015.0261] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Penicillin-resistant Streptococcus pneumoniae is a serious concern worldwide. In this study, we analyzed the cause of β-lactam resistance in pandemic multidrug-resistant clones. A total of 41 penicillin-nonsusceptible clinical isolates were collected from 1996 to 2012. Sero- and molecular typing confirmed that these isolates were clonal types of Taiwan19F-14, Taiwan23F-15, and Spain23F-1. Sero-switching was found in four isolates. All isolates were multidrug resistant. Sequencing analysis of the penicillin binding proteins (PBPs) was performed on PBP1a, 2b, and 2x, and a large number of mutations were identified in comparing to clinical penicillin-susceptible isolates and the recipient strain R6 used for homologous recombination. The T451A substitution was the key amino acid in PBP2b that contributed to penicillin resistance. T338A in PBP2x played a role in resistance and reached the highest level of resistance when combined with other mutations in PBP2x. High-level penicillin resistance could not be obtained without the combination of mutations in PBP1a with PBP2b and 2x. The amino acid substitutions in PBP1a, 2b, and 2x were the crucial factors for β-lactam resistance.
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Affiliation(s)
- Esther Yip-Mei Liu
- 1 Institute of Clinical Medicine, School of Medicine, National Yang-Ming University , Taipei, Taiwan
| | - Jen-Chang Chang
- 2 Institute of Infectious Diseases and Vaccinology, National Health Research Institutes , Zhunan, Taiwan
| | - Jung-Chung Lin
- 3 Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center , Taipei, Taiwan
| | - Feng-Yee Chang
- 3 Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center , Taipei, Taiwan
| | - Chang-Phone Fung
- 1 Institute of Clinical Medicine, School of Medicine, National Yang-Ming University , Taipei, Taiwan .,4 Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital and National Yang-Ming University , Taipei, Taiwan
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Kuo CY, Hwang KP, Hsieh YC, Cheng CH, Huang FL, Shen YH, Huang YC, Chiu CH, Chen PY, Lin TY. Nasopharyngeal carriage of Streptococcus pneumoniae in Taiwan before and after the introduction of a conjugate vaccine. Vaccine 2011; 29:5171-7. [PMID: 21621578 DOI: 10.1016/j.vaccine.2011.05.034] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Revised: 05/11/2011] [Accepted: 05/12/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND The heptavalent pneumococcal conjugate vaccine was introduced in Taiwan in October 2005. To evaluate the effect of the vaccination, we conducted an active, prospective, large-scale, long-term, and multicenter study to assess the prevalence of nasopharyngeal Streptococcus pneumoniae carriage in Taiwanese children. METHODS This study was performed at three tertiary teaching hospitals in northern, central, and southern Taiwan. Questionnaires provided demographic, family/household, and medical history data. Pneumococcal isolates were tested for their susceptibility to various antimicrobial agents and serotypes. In addition, influenza virus and Staphylococcus aureus were recovered from nasopharyngeal and nasal swabs, respectively. RESULTS Between July 2005 and July 2008, 857 pneumococcal strains were recovered from a total of 6057 children aged >2 months to 5 years (carriage rate, 14.1%). Carriage rates differed geographically and varied with subject age. In a multivariate analysis, having at least one sibling, attendance at day-care centers, a history of otitis media, and history of upper respiratory tract infection in the previous 2 weeks were each associated with a higher risk of pneumococcal colonization of the nasopharynx. Staphylococcus aureus nasal colonization was inversely associated with nasopharyngeal carriage of pneumococcus (p=0.000; odds ratio [OR]: 0.48; 95% CI: 0.39-0.58). Daycare attendance was the only risk factor for carriage of penicillin non-susceptible S. pneumoniae (OR: 2.37; 95% CI: 1.22-4.88). Although vaccination rates rose from 2005 to 2008, no concomitant decrease in S. pneumoniae carriage occurred. The rate of penicillin resistance among S. pneumoniae isolates was 92.8% (using the meningitis criteria). The prevalence of cefotaxime resistance (21.6%) was higher than that of penicillin (6.9%; non-meningitis criteria). Slightly more than half (57.4%) of the isolates belonged to strains covered by the heptavalent pneumococcal conjugate vaccine when both vaccine and vaccine-related serotypes were included. CONCLUSIONS Although vaccination rates rose from 2005 to 2008, no concomitant decrease occurred in S. pneumoniae carriage. Interaction between S. aureus and S. pneumoniae may influence vaccination efficacy. These findings provide baseline data to further compare pneumococcal carriage rates and antibiotic resistance patterns in Taiwanese children as vaccination rates continue to increase.
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Affiliation(s)
- Chen-Yen Kuo
- Department of Pediatrics, Chang Gung Children's Hospital, College of Medicine, Chang Gung University, 5 Fu-Hsin Street, Kwei-Shan Hsiang, Taoyuan, Taiwan
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10
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Lo WT, Lin WJ, Chiueh TS, Lee SY, Wang CC, Lu JJ. Changing trends in antimicrobial resistance of major bacterial pathogens, 1985-2005: a study from a medical center in northern Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2011; 44:131-8. [PMID: 21439516 DOI: 10.1016/j.jmii.2010.02.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Revised: 12/02/2009] [Accepted: 02/10/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND Antimicrobial resistance is a major health problem worldwide. We evaluated the antimicrobial resistance trends of 16 major bacterial pathogens at a tertiary medical center in northern Taiwan. METHODS We conducted a retrospective review of annual summary documents for antimicrobial susceptibility of clinically isolated gram-positive and gram-negative bacteria from 1985 to 2005. The numbers of isolates and susceptibilities were calculated for three 7-year periods: first period, 1985-1991; second period, 1992-1998; and the third period, 1999-2005. RESULTS During the 21-year period, 219,715 bacterial pathogens were identified. A significant increase in incidence over time was found for methicillin-resistant Staphylococcus aureus, methicillin-resistant S epidermidis, penicillin-nonsusceptible Streptococcus pneumoniae, erythromycin-resistant S pneumoniae, vancomycin-resistant enterococci, cefotaxime/ceftriaxone-resistant Escherichia coli and Klebsiella pneumoniae, and imipenem-resistant Acinetobacter baumannii. Additionally, a significant increase in ciprofloxacin resistance rates over time from 1996 to 2005 was noted for E coli, Enterobacter cloacae, and A baumannii (through 1997 to 2005). However, a significant decrease in erythromycin resistance rate with time from 1999 to 2005 was found for Groups A and B streptococci, non-A, B, D streptococci, and S pneumoniae. CONCLUSION Resistance to antimicrobial agents increased rapidly in the past two decades in Taiwan and has become very common in major bacterial pathogens. Continuous enforcement of policies to limit use of antimicrobial agents and active surveillance of antimicrobial resistance through a nationwide system are both warranted.
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Affiliation(s)
- Wen-Tsung Lo
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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11
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Summary of invasive pneumococcal disease burden among children in the Asia-Pacific region. Vaccine 2010; 28:7589-605. [PMID: 20674872 DOI: 10.1016/j.vaccine.2010.07.053] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Revised: 07/14/2010] [Accepted: 07/18/2010] [Indexed: 11/22/2022]
Abstract
Invasive pneumococcal disease (IPD) burden is significant in the Asia-Pacific region. This review describes the epidemiology and Streptococcus pneumoniae (SP) serotype distribution of IPD in children in the Asia-Pacific region from studies published from 1999 to 2010. IPD incidence varies widely in Asia-Pacific countries depending on the method of surveillance, the population studied, and the time period. Incidences are highest for younger children, with rates near 100-200 cases per 100,000 children aged <1 or 2 years. Incidences of preventable disease are estimated to be 6-200 cases per 100,000. Heptavalent pneumococcal conjugate vaccine (PCV7) serotype coverage shows a very wide range over the Asia-Pacific region. Ten countries have high vaccine serotype coverage (>70%), and six countries have low vaccine serotype coverage (<50%). The majority of SP serotypes in children with IPD in most countries in the Asia-Pacific region are susceptible to penicillin (intermediate and resistant <50%); a few countries have SP serotypes with high level resistance to penicillin (intermediate and resistant >50%). Japan, Taiwan, and Thailand have high PCV7 serotype coverage. Countries with low pneumococcal resistance to antimicrobials have shown increasingly higher nonsusceptibility with time. National vaccination programmes that include PCV7, 10-valent pneumococcal conjugate vaccine (PCV), or 13-valent PCV would significantly affect IPD burden in children aged <5 years in the Asia-Pacific region, as well as the burden of penicillin-nonsusceptible IPD.
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12
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Macrolide combination antibiotic therapy should be prudently considered in complicated CAP cases and in regions with low macrolide susceptibility. Intensive Care Med 2010; 36:1788. [PMID: 20631990 DOI: 10.1007/s00134-010-1946-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2010] [Indexed: 10/19/2022]
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13
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Srifeungfung S, Tribuddharat C, Comerungsee S, Chatsuwan T, Treerauthanaweeraphong V, Rungnobhakhun P, Nunthapisud P, Chokephaibulkit K. Serotype coverage of pneumococcal conjugate vaccine and drug susceptibility of Streptococcus pneumoniae isolated from invasive or non-invasive diseases in central Thailand, 2006–2009. Vaccine 2010; 28:3440-4. [DOI: 10.1016/j.vaccine.2010.02.071] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2009] [Revised: 01/29/2010] [Accepted: 02/15/2010] [Indexed: 10/19/2022]
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Mainous AG, Diaz VA, Carnemolla M. A community intervention to decrease antibiotics used for self-medication among Latino adults. Ann Fam Med 2009; 7:520-6. [PMID: 19901311 PMCID: PMC2775608 DOI: 10.1370/afm.1061] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Recent evidence in Latino communities indicates substantial self-medication with antibiotics obtained without a prescription (WORx). We implemented and evaluated a culturally sensitive educational intervention to decrease antibiotic self-medication. METHODS We conducted a community-based intervention with preintervention and postintervention measures in the intervention community (Charleston, South Carolina) as well as a postintervention measure in a control community (Greenville, South Carolina) 200 miles away. The 9-month culturally sensitive intervention included multiple media sources (pamphlets, radio, newspapers). We evaluated the use of antibiotics WORx in the United States, as well as the likelihood of importing antibiotics, by surveying Latino adults in the intervention (n = 250) and in the control community (n = 250). RESULTS Most adults in the intervention community (69%) and the control community (60%) reported some exposure to messages about the inappropriate use of antibiotics, and 25.9% in the intervention community and 8.6% in the control community reported seeing our patient education pamphlets. A substantial proportion of Latino adults in both the intervention (31%) and control communities (20%) have obtained antibiotics WORx in the United States. In multivariate analyses, exposure to an educational message was not a significant predictor of having acquired antibiotics WORx in the United States in past 12 months. The primary predictor of respondents' having acquired antibiotics WORx in the United States was whether they had bought antibiotics WORx outside the United States. CONCLUSIONS Novel approaches are needed to decrease the use of antibiotics WORx in Latino communities, as focusing only on education may not be sufficient to change behaviors common in their home countries.
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Affiliation(s)
- Arch G Mainous
- Department of Family Medicine, Medical University of South Carolina, 295 Calhoun St Charleston, SC 29425 USA.
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15
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Mainous AG, Everett CJ, Post RE, Diaz VA, Hueston WJ. Availability of antibiotics for purchase without a prescription on the internet. Ann Fam Med 2009; 7:431-5. [PMID: 19752471 PMCID: PMC2746509 DOI: 10.1370/afm.999] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Reducing inappropriate use of antibiotics is key to many antibiotic resistance initiatives. Most initiatives, however, focus almost exclusively on controlling prescribing by health care clinicians and do not focus on patient self-medication. The purpose of this study was to examine antibiotics available to patients without a prescription, a phenomenon on the Internet. METHODS We conducted an Internet search using 2 major search engines (Google and Yahoo) with the key words "purchase antibiotics without a prescription" and "online (English only)." Vendors were compared according to the classes of antibiotics available, quantity, shipping locations, and shipping time. RESULTS We found 138 unique vendors selling antibiotics without a prescription. Of those vendors, 36.2% sold antibiotics without a prescription, and 63.8% provided an online prescription. Penicillins were available on 94.2% of the sites, macrolides on 96.4%, fluoroquinolones on 61.6%, and cephalosporins on 56.5%. Nearly all, 98.6%, ship to the United States. The mean delivery time was 8 days, with 46.1% expecting delivery in more than 7 days. Among those selling macrolides (n = 133), 93.3% would sell azithromycin in quantities consistent with more than a single course of medication. Compared with vendors that require a medical interview, vendors who sell antibiotics without a prescription were more likely to sell quantities in excess of a single course, and the antibiotics were more likely to take more than 7 days to reach the customer. CONCLUSIONS Antibiotics are freely available for purchase on the Internet without a prescription, a phenomenon that encourages self-medication and low quality of care.
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Affiliation(s)
- Arch G Mainous
- Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
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16
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Host and microbiologic factors associated with mortality in Taiwanese children with invasive pneumococcal diseases, 2001 to 2006. Diagn Microbiol Infect Dis 2009; 63:194-200. [PMID: 19150710 DOI: 10.1016/j.diagmicrobio.2008.10.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2008] [Revised: 10/04/2008] [Accepted: 10/07/2008] [Indexed: 11/22/2022]
Abstract
We concurrently evaluated host- and organism-related factors in determining the outcomes of 160 invasive pneumococcal diseases episodes in 158 Taiwanese children during 2001 and 2006. Most (138/160, 86.2%) episodes occurred at age less than 60 months, and an underlying condition was present in 35 (22.2%) cases. Common disease syndromes included complicated pneumonia (29.4%), uncomplicated pneumonia (29.4%), occult bacteremia (17.5%), and meningitis (14.4%). Mortality (13/160, 8.1%) was associated with age less than 24 months, underlying conditions, meningitis, cytopenia, intensive care, and penicillin MIC >or=2 microg/mL in univariate analysis. Pneumococcal serotypes, genotypes, origin of infections, and discordant therapy did not influence the outcome. Multivariate analysis determined the presence of underlying conditions (adjusted odds ratio [OR], 30.5; 95% confidence interval [CI], 4.8-193.1) and penicillin MIC >or=2 microg/mL (adjusted OR, 8.1; 95% CI, 1.4-47.3), which are the independent predictors for fatality. This finding highlighted the importance of immunization of disadvantaged children, targeting drug-resistant pneumococci.
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National survey of invasive pneumococcal diseases in Taiwan under partial PCV7 vaccination in 2007: emergence of serotype 19A with high invasive potential. Vaccine 2009; 27:5513-8. [PMID: 19615960 DOI: 10.1016/j.vaccine.2009.06.091] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2009] [Revised: 06/10/2009] [Accepted: 06/29/2009] [Indexed: 11/20/2022]
Abstract
We conducted an active, population-based laboratory surveillance study to evaluate the epidemiologic features of invasive pneumococcal disease (IPD) in Taiwan. Concurrently, nasopharyngeal colonization of Streptococcus pneumoniae was evaluated among 1128 healthy children aged <or=5 years. The overall incidence was highest among children aged 2-4 years (15.6/100,000). Serotype 19A, which had never been reported in Taiwan previously, caused a substantial fraction of the invasive diseases (OR, 9.6; 95% CI, 3.1-29.4) among children aged 2-4 years. Comparing serotype distributions of the isolates from nasopharyngeal colonization among children aged <or=5 years, serotypes 14 (OR, 17.3; 95% CI, 5.2-57.9) and 19A (OR, 14.9; 95% CI, 1.9-117) had the highest invasive potential. The study found that serotype 19A expanded in Taiwan, a country with a low 7-valent conjugate pneumococcal vaccine coverage. The 7-valent conjugate pneumococcal vaccines covered 73% of cases in children aged between 2 and 4 years, and 64.7% of cases in children aged <2 years. Among patients aged >or=65 years, the 23-valent pneumococcal polysaccharide vaccine covered 70.4% of cases. In the future, a broader pneumococcal vaccine is needed.
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Rossoni AMDO, Dalla Costa LM, Berto DB, Farah SS, Gelain M, Brandileone MCDC, Ramos VHM, Almeida SMD. Acute bacterial meningitis caused by Streptococcus pneumoniae resistant to the antimicrobian agents and their serotypes. ARQUIVOS DE NEURO-PSIQUIATRIA 2008; 66:509-15. [DOI: 10.1590/s0004-282x2008000400014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2008] [Accepted: 06/17/2008] [Indexed: 11/22/2022]
Abstract
The main objectives of this study are to evaluate the resistance rates of Streptococcus pneumonia to penicillin G, ceftriaxone and vancomycin in patients with meningitis; to analyze possible risk factors to the antimicrobian resistance; to describe the serotypes detected and to suggest an initial empirical treatment for meningitis. The sensitiveness and serotypes of all isolated S. pneumoniae of patients with acute bacterial meningitis received by the Paraná State Central Laboratory from April 2001 to august 2002 have been evaluated. One hundred S. pneumoniae have been isolated, of which 15% were resistant to penicillin, 1% to cephalosporin and 0% to vancomycin. The serotypes most found were 14 (19%), 3 and 23F (10% each). When only the resistant serotypes were analyzed, the most prevalent was the 14 with 44%. The risk factors found in relation to the S. pneumoniae resistance were: age under one year old (p=0.01) and previous use of antibiotic (p=0.046). The resistance rates found, which were moderate to penicillin, low to cephalosporin and neutral to vancomycin, suggest the isolated use of a 3rd generation cephalosporin as an initial empirical therapy for the treatment of acute bacterial meningitis with a communitarian background.
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19
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Chen CJ, Huang YC, Su LH, Lin TY. Nasal carriage of Streptococcus pneumoniae in healthy children and adults in northern Taiwan. Diagn Microbiol Infect Dis 2007; 59:265-9. [PMID: 17900847 DOI: 10.1016/j.diagmicrobio.2007.05.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2007] [Revised: 05/15/2007] [Accepted: 05/22/2007] [Indexed: 11/17/2022]
Abstract
A total of 427 subjects were surveyed for the carriage of Streptococcus pneumoniae before the introduction of pneumococcal conjugate vaccine in northern Taiwan. Positive results were identified in 27% of 94 children attending 6 classes in a child care center (CCC), 14% of 122 pupils attending 4 classes in 2 elementary schools, and 1.4% of 74 adolescents attending 3 classes in a junior middle school. None of 137 health care workers working in neonatal intensive care units of a university-affiliated hospital was colonized with S. pneumoniae. Three (12%) of 25 isolates from the children attending the CCC were susceptible to penicillin (MIC <0.1 microg/mL), whereas 8 (44%) of 18 isolates from the pupils and adolescents were susceptible (P = 0.0312). Of the 43 isolates, 11 serotypes were identified and serotypes/serogroups 6 (13 isolates), 23 (10 isolates), and 19 (7 isolates) were the 3 most common serotypes/serogroups. The genotypes of the 43 isolates were diverse, but it was not infrequently seen that several isolates from the subjects in a single class shared a common genotype. Conclusively, the carriage rate of S. pneumoniae is inversely correlated with the age of the subjects. The isolates from the children attending the CCC had a significantly higher penicillin-nonsusceptible rate than those from the pupils and adolescents. Transmission of the same clone in a single class may have frequently occurred.
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Affiliation(s)
- Chih-Jung Chen
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Children's Hospital, Kweishan 333, Taoyuan, Taiwan
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20
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Lai CC, Lee LN, Yu CJ, Hsueh PR, Yang PC, Kuo SH, Luh KT. Antibody responses to pneumococcal polysaccharide vaccine in Taiwanese patients with chronic obstructive pulmonary disease. J Formos Med Assoc 2007; 106:196-203. [PMID: 17389163 DOI: 10.1016/s0929-6646(09)60240-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND/PURPOSE A study was undertaken to assess the antibody responses to a 23-valent pneumococcal polysaccharide vaccine and clinical outcome in Taiwanese patients with chronic obstructive pulmonary disease (COPD). METHODS From January to December 1999, 80 Taiwanese patients with COPD were enrolled. Each patient received a 23-valent pneumococcal polysaccharide vaccine (Pneumovax 23). Specific IgG antibodies to pneumococcal capsular antigens of serotypes 4, 6B, 7F, 9V, 14, 18C, 19F, and 23F were measured before vaccination, and 6 weeks and 52 weeks after vaccination. RESULTS Detectable prevaccination IgG antibody (> 1 microg/mL) was found in the range of 27.5% of patients for serotype 7F to 96.2% for serotype 14. Antibody concentrations in prevaccination sera were not different between middle-aged (< 65 years old) and elderly patients (> or = 65 years old). The percentage of elderly patients with postvaccination antibody concentration > 2 -fold higher than that prior to vaccination ranged from 84% for serotype 18C to 90% for serotypes 7F, 9V, and 19F. The change in antibody level (fold and absolute increases) postvaccination was not significantly different among the different age groups. CONCLUSION Taiwanese elderly adults with COPD, even in advanced age, can mount a significant antibody response to pneumococcal polysaccharide vaccine. This study may support the existing recommendation that pneumococcal vaccine be offered to persons > or = 65 years old with COPD.
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Affiliation(s)
- Chih-Cheng Lai
- Division of Critical Care Medicine, Lotung Poh-Ai Hospital, Yi-Lan, Taiwan
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21
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Hsueh PR, Shyr JM, Wu JJ. Changes in macrolide resistance among respiratory pathogens after decreased erythromycin consumption in Taiwan. Clin Microbiol Infect 2006; 12:296-8. [PMID: 16451421 DOI: 10.1111/j.1469-0691.2005.01348.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Measures to alleviate the growing problem of macrolide resistance in Taiwan resulted in a decrease in macrolide consumption, from 0.629 defined daily doses/1000 inhabitants per day (DIDs) in 1999 to 0.301 DIDs in 2003 (a reduction of 52%). A linear relationship was observed between the decline in erythromycin consumption and the decline in erythromycin resistance in Streptococcus pyogenes (46% in 1999 vs. 17% in 2003; p < 0.001) and azithromycin resistance in Haemophilus influenzae (31% in 2000 vs. 0% in 2003; p < 0.001). However, the rate of erythromycin resistance in Streptococcus pneumoniae showed a continued increase, from 80.2% in 1999 to 92% in 2003.
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Affiliation(s)
- P-R Hsueh
- Departments of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei.
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Hsueh PR. Decreasing rates of resistance to penicillin, but not erythromycin, in Streptococcus pneumoniae after introduction of a policy to restrict antibiotic usage in Taiwan. Clin Microbiol Infect 2005; 11:925-7. [PMID: 16216110 DOI: 10.1111/j.1469-0691.2005.01245.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A 16% decline in rates of penicillin resistance in Streptococcus pneumoniae isolates in Taiwan between 1998--1999 (25%) and 2001 (9%) was associated with a 46% decrease in total penicillin and other cephalosporin usage in 2001 compared with 1999. However, erythromycin resistance in S. pneumoniae remained high (94%), despite a 45% decrease in macrolide consumption between 1999 and 2001.
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Affiliation(s)
- P-R Hsueh
- Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taiwan.
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Okeke IN, Laxminarayan R, Bhutta ZA, Duse AG, Jenkins P, O'Brien TF, Pablos-Mendez A, Klugman KP. Antimicrobial resistance in developing countries. Part I: recent trends and current status. THE LANCET. INFECTIOUS DISEASES 2005; 5:481-93. [PMID: 16048717 DOI: 10.1016/s1473-3099(05)70189-4] [Citation(s) in RCA: 447] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The global problem of antimicrobial resistance is particularly pressing in developing countries, where the infectious disease burden is high and cost constraints prevent the widespread application of newer, more expensive agents. Gastrointestinal, respiratory, sexually transmitted, and nosocomial infections are leading causes of disease and death in the developing world, and management of all these conditions has been critically compromised by the appearance and rapid spread of resistance. In this first part of the review, we have summarised the present state of resistance in these infections from the available data. Even though surveillance of resistance in many developing countries is suboptimal, the general picture is one of accelerating rates of resistance spurred by antimicrobial misuse and shortfalls in infection control and public health. Reservoirs for resistance may be present in healthy human and animal populations. Considerable economic and health burdens emanate from bacterial resistance, and research is needed to accurately quantify the problem and propose and evaluate practicable solutions. In part II, to be published next month, we will review potential containment strategies that could address this burgeoning problem.
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Affiliation(s)
- Iruka N Okeke
- Department of Biology, Haverford College, Haverford, PA, USA
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Abstract
Newer fluoroquinolones such as levofloxacin, moxifloxacin, gatifloxacin and gemifloxacin have several attributes that make them excellent choices for the therapy of lower respiratory tract infections. In particular, they have excellent intrinsic activity against Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and the atypical respiratory pathogens. Fluoroquinolones may be used as monotherapy to treat high-risk patients with acute exacerbation of chronic bronchitis, and for patients with community-acquired pneumonia requiring hospitalisation, but not admission to intensive care. Overall, the newer fluoroquinolones often achieve clinical cure rates in > or =90% of these patients. However, rates may be lower in hospital-acquired pneumonia, and this infection should be treated on the basis of anticipated organisms and evaluation of risk factors for specific pathogens such as Pseudomonas aeruginosa. In this setting, an antipseudomonal fluoroquinolone may be used in combination with an antipseudomonalbeta-lactam. Concerns are now being raised about the widespread use, and possibly misuse, of fluoroquinolones and the emergence of resistance among S. pneumoniae, Enterobacteriaceae and P. aeruginosa. A number of pharmacokinetic parameters such as the peak concentration of the antibacterial after a dose (C(max)), and the 24-hour area under the concentration-time curve (AUC24) and their relationship to pharmacodynamic parameters such as the minimum inhibitory and the mutant prevention concentrations (MIC and MPC, respectively) have been proposed to predict the effect of fluoroquinolones on bacterial killing and the emergence of resistance. Higher C(max)/MIC or AUC24/MIC and C(max)/MPC or AUC24/MPC ratios, either as a result of dose administration or the susceptibility of the organism, may lead to a better clinical outcome and decrease the emergence of resistance, respectively. Pharmacokinetic profiles that are optimised to target low-level resistant minor subpopulations of bacteria that often exist in infections may help preserve fluoroquinolones as a class. To this end, optimising the AUC24/MPC or C(max)/MPC ratios is important, particularly against S. pneumoniae, in the setting of lower respiratory tract infections. Agents such as moxifloxacin and gemifloxacin with high ratios against this organism are preferred, and agents such as ciprofloxacin with low ratios should be avoided. For agents such as levofloxacin and gatifloxacin, with intermediate ratios against S. pneumoniae, it may be worthwhile considering alternative dose administration strategies, such as using higher dosages, to eradicate low-level resistant variants. This must, of course, be balanced against the potential of toxicity. Innovative approaches to the use of fluoroquinolones are worth testing in further in vitro experiments as well as in clinical trials.
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Affiliation(s)
- Wael E. Shams
- Division of Infectious Diseases, Department of Internal Medicine, University of Kentucky School of Medicine, Room MN 672, 800 Rose Street, Lexington, Kentucky 40536 USA
- Department of Internal Medicine, University of Alexandria Faculty of Medicine, Alexandria, Egypt
- Division of Infectious Diseases, Department of Internal Medicine, East Tennessee State University, Johnson City, Tennessee USA
| | - Martin E. Evans
- Division of Infectious Diseases, Department of Internal Medicine, University of Kentucky School of Medicine, Room MN 672, 800 Rose Street, Lexington, Kentucky 40536 USA
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Mainous AG, Cheng AY, Garr RC, Tilley BC, Everett CJ, McKee MD. Nonprescribed antimicrobial drugs in Latino community, South Carolina. Emerg Infect Dis 2005; 11:883-8. [PMID: 15963283 PMCID: PMC3367598 DOI: 10.3201/eid1106.040960] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We investigated in a sample of Latinos the practices of antimicrobial drug importation and use of nonprescribed antimicrobial drugs. In interviews conducted with 219 adults, we assessed health beliefs and past and present behaviors consistent with acquiring antimicrobial drugs without a prescription in the United States. Many (30.6%) believed that antimicrobial drugs should be available in the United States without a prescription. Furthermore, 16.4% had transported nonprescribed antimicrobial drugs into the United States, and 19.2% had acquired antimicrobial agents in the United States without a prescription. A stepwise logistic regression analysis showed that the best predictors of having acquired nonprescribed antimicrobial drugs in the United States were beliefs and behavior consistent with limited regulations on such drugs. Many persons within the Latino community self-medicate with antimicrobial drugs obtained without a prescription both inside and outside the United States, which adds to the reservoir of antimicrobial drugs in the United States.
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Affiliation(s)
- Arch G Mainous
- Medical University of South Carolina, Charleston, South Carolina 29425, USA.
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Vanderkooi OG, Low DE, Green K, Powis JE, McGeer A. Predicting Antimicrobial Resistance in Invasive Pneumococcal Infections. Clin Infect Dis 2005; 40:1288-97. [PMID: 15825031 DOI: 10.1086/429242] [Citation(s) in RCA: 186] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2004] [Accepted: 12/19/2004] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The prevalence of multiantimicrobial resistance among Streptococcus pneumoniae continues to increase worldwide. In patients presenting with infection possibly due to pneumococci, recognition of risk factors that would identify those likely to have an antibiotic-resistant isolate might assist clinicians in choosing the most appropriate empirical therapy. METHODS A prospective cohort study of invasive pneumococcal infection was conducted in Toronto, Canada. Risk factors for antimicrobial resistance were evaluated by means of univariate and multivariate modeling. RESULTS A total of 3339 patients with invasive pneumococcal infection were identified between 1995 and 2002. Multivariate modeling revealed that risk factors for infection with penicillin-resistant as opposed to penicillin-susceptible pneumococci were year of infection (odds ratio [OR], 1.28; P < .001), absence of chronic organ system disease (OR, 1.72; P = .03), and previous use of penicillin (OR, 2.47; P = .006), trimethoprim-sulfamethoxazole (TMP-SMX; OR, 5.97; P < .001), and azithromycin (OR, 2.78; P = .05). Infection with TMP-SMX-resistant pneumococci was associated with absence of chronic organ system disease (OR, 1.64; P = .001) and with previous use of penicillin (OR, 1.71; P = .03), TMP-SMX (OR, 4.73; P < .001), and azithromycin (OR, 3.49; P = .001). Infection with macrolide-resistant isolates was associated with previous use of penicillin (OR, 1.77; P = .03), TMP-SMX (OR, 2.07; P = .04), clarithromycin (OR, 3.93; P < .001), and azithromycin (OR, 9.93; P < .001). Infection with fluoroquinolone-resistant pneumococci was associated with previous use of fluoroquinolones (OR, 12.1; P < .001), current residence in a nursing home (OR, 12.9; P < .001), and nosocomial acquisition of pneumococcal infection (OR, 9.94; P = .003). CONCLUSIONS Knowledge of antimicrobial use during the 3 months before infection is crucial for determining appropriate therapy for a patient presenting to the hospital with an illness for which S. pneumoniae is a possible cause. Nosocomial acquisition and nursing home acquisition are significant risk factors for infection with fluoroquinolone-resistant pneumococci.
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Affiliation(s)
- Otto G Vanderkooi
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
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Lauderdale TL, Chang FY, Ben RJ, Yin HC, Ni YH, Tsai JW, Cheng SH, Wang JT, Liu YC, Cheng YW, Chen ST, Fung CP, Chuang YC, Cheng HP, Lu DCT, Liu CJ, Huang IW, Hung CL, Hsiao CF, Ho M. Etiology of community acquired pneumonia among adult patients requiring hospitalization in Taiwan. Respir Med 2005; 99:1079-86. [PMID: 16085210 DOI: 10.1016/j.rmed.2005.02.026] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2004] [Indexed: 11/21/2022]
Abstract
BACKGROUND There has not been a comprehensive multi-center study investigating the microbial profile of community acquired pneumonia (CAP) in Taiwan. METHODS A prospective study of adult CAP patients requiring hospitalization between December 2001 and April 2002 was carried out in 13 hospitals in Taiwan. Etiology was determined based on laboratory data from blood and sputum cultures plus serology from paired serum and urine antigen detection tests. RESULTS Etiology was assigned to 99 (58.9%) of the 168 patients having the most complete data for etiology determination, with mixed infection in 21 (12.5%) patients. More than half (51.8%) of the patients were>60 years and 63.7% of the patients were males. The most common etiologic agent was Streptococcus pneumoniae (40, 23.8%), the majority (60%, 24 cases) of which was detected by positive urine antigen test. Other common agents included Mycoplasma pneumoniae (24, 14.3%), Chlamydia pneumoniae (12, 7.1%), Influenza A virus (11, 6.5%), Klebsiella pneumoniae (8, 4.8%) and Haemophilus influenzae (8, 4.8%). The prevalence of S. pneumoniae and M. pneumoniae was highest in patients>60 years (25/87, 28.7%), and<44 years (12/59, 19%), respectively; while K. pneumoniae comprised a larger proportion (4/22, 18%) in the 45-59 years group. CONCLUSIONS S. pneumoniae was the most common etiology agent in adult patients hospitalized due to CAP in Taiwan and the spectrum of other major pathogens was similar to studies conducted elsewhere in the world. Empiric treatment recommendations developed in other parts of the world may be appropriately adapted for local use after taking into account local resistance profiles. Our data also support the recommendation that urine antigen test be added as an adjunct to adult CAP etiology diagnosis protocol.
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Affiliation(s)
- Tsai-Ling Lauderdale
- Division of Clinical Research, National Health Research Institutes, Taipei, Taiwan
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Ko WC, Yan JJ, Lee NY, Wu HM, Wu JJ. Polyclonal Spread of Erythromycin-ResistantStreptococcus agalactiaein Southern Taiwan. Microb Drug Resist 2004; 10:306-12. [PMID: 15650375 DOI: 10.1089/mdr.2004.10.306] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Resistance to erythromycin is common among Streptococcus agalactiae in Taiwan, however the genetic relatedness of erythromycin-resistant isolates has not yet been reported. From 1991 to 2001, 629 clinical isolates of S. agalactiae were collected in a medical center at Tainan in southern Taiwan, of which 189 (30.0%) were resistant to erythromycin. The isolation rate of erythromycin-resistant group B streptococcus (GBS) was stable, irrespective of the clinical sources or study period. Among them, 145 (76.7%) isolates showed the macrolide-lincosamide-streptogramin B (MLS)-resistant phenotype, and 44 (23.3%) had the macrolide (M)- resistant phenotype. Of the isolates with MLS phenotype, 141 (97.2%) isolates harbored the ermB gene alone and only three (2.1%) the ermTR gene, whereas 41 (93.2%) of 44 isolates with M phenotype harbored the mefA/E gene. Of 177 typeable isolates, there were 26 unrelated pulsed-field gel electrophoresis (PFGE) patterns. PFGE type 1 accounted for 17.8% (24/135) of MLS phenotype isolates with the ermB gene and 48.7% (18/37) of M phenotype isolates with the mefA/E gene. During the study period, the proportion of PFGE type 6 decreased significantly, whereas that of type 8 increased. Our results suggest that erythromycin resistance is not uncommon among clinical isolates of S. agalactiae and is, at least, partially related to polyclonal spread in southern Taiwan.
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Affiliation(s)
- Wen-Chien Ko
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
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Hsieh YC, Hsueh PR, Lu CY, Lee PI, Lee CY, Huang LM. Clinical manifestations and molecular epidemiology of necrotizing pneumonia and empyema caused by Streptococcus pneumoniae in children in Taiwan. Clin Infect Dis 2004; 38:830-5. [PMID: 14999627 DOI: 10.1086/381974] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2003] [Accepted: 11/18/2003] [Indexed: 11/03/2022] Open
Abstract
Recently, there have been increasing numbers of pneumococcal pneumonia cases, with their associated complications. We conducted a retrospective review to increase the understanding of childhood pneumococcal pneumonia. Seventy-one patients with pneumococcal pneumonia were identified. Forty (56.3%) of them developed complicated pneumonia. Multivariate analysis showed that presence of immature polymorphonuclear leukocytes in peripheral blood (odds ratio [OR], 3.67; 95% confidence interval [CI], 1.08-12.63), high C-reactive protein levels (>12 mg/dL) (OR, 5.24; 95% CI, 1.10-24.93), and no underlying disease at presentation (OR, 5.48; 95% CI, 1.06-28.25) were independent predictors of the occurrence of necrosis or/and abscess. Fourteen isolates (35%), which were genotypically identical and had the same pulsed-field gel electrophoresis pattern (serogroup 14, with MICs of penicillin of 0.1-0.5 mu g/mL), were significantly associated with complicated pneumonia (P=.047). Whether the virulence of antibiotic-resistant pneumococci is evolving deserves further investigation.
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Affiliation(s)
- Yu-Chia Hsieh
- Department of Pediatrics, Far Eastern Memorial Hospital, Taipei, Taiwan
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