Serotype distribution and antimicrobial resistance of pediatric Streptococcus pneumoniae isolated from inpatients and outpatients at Beijing Children's Hospital

BACKGROUND

Understanding the epidemiology of Streptococcus pneumoniae (S. pneumoniae) isolates is important for pneumonia treatment and prevention. This research aimed to explore the epidemiological characteristics of S. pneumoniae isolated from pediatric inpatients and outpatients during the same period.

METHODS

S. pneumoniae were isolated from unsterile samples of inpatients and outpatients younger than five years old between March 2013 and February 2014. The serotypes were determined using diagnostic pneumococcal antisera. The resistance of each strain to 13 antibiotics was tested using either the E-test or the disc diffusion method. The Sequence Types (STs) were analyzed via Multilocus Sequence Typing (MLST).

RESULTS

The dominant serotypes obtained from inpatients were 19F (32.9 %), 19A (20.7 %), 23F (10.7 %), 6A (10.0 %), and 14 (8.6 %), while those from outpatients were 19F (13.6 %), 23F (12.9 %), 6A (10.0 %), 6B (10.0 %), and 19A (7.9 %). The coverage rates of 13-valent Pneumococcal Conjugate Vaccine (PCV) formulations were high in both groups. The nonsusceptibility to penicillin, cefuroxime, imipenem, erythromycin, and trimethoprim-sulfamethoxazole among the inpatient isolates was 7.1 %, 92.8 %, 65.7 %, 100 %, and 85.0 %, respectively, while that among the outpatient isolates was 0.7 %, 50.0 %, 38.6 %, 96.4 %, and 65.7 %, respectively. There were 45 and 81 STs detected from the pneumococci isolated from inpatients and outpatients, respectively. CC271 was common among both inpatients and outpatients (43.6 % and 14.3 %).

CONCLUSIONS

Pneumococcal vaccine-related serotypes are prevalent among both inpatients and outpatients, especially among inpatients, who exhibit more severe antibiotic resistance. Therefore, universal immunization with PCV13 would decrease the hospitalization rate due to S. pneumoniae and the antibiotic resistance rate of S. pneumoniae.

Health Care Innovation for Low-Resource Settings: The Value of Local Immersion and Partnership

Health Care Innovation is the creation, development, and translation of new and better solutions to health care challenges. At its core, this endeavor does not require extending the frontiers of science or the creation of new fundamental technologies. Rather, it is primarily focused on the use of existing science and established technologies in the design of new solutions to problems in health care. Successfully innovating for low- and middle-income countries (LMICs) requires a needs and stakeholder-driven approach to enable development and adoption of available, accessible, and acceptable solutions tailored to the specific need and context of care.

Kidney biopsy in subsaharan Africa

Kidney biopsy (KB) is a significant advance in the management of nephropathies. In sub-Saharan Africa, few studies have been carried out. The objective of our study was to evaluate the indication, to determine the epidemiological and histological characteristics of the nephropathies diagnosed in sub-Saharan Africa.

Materials and methods

We carried out a retrospective and descriptive study on biopsies examined between January 2015 and December 2019, in the pathological departments of University Teaching Hospital of Bouaké and Cocody-Abidjan. The KB came from four countries (Côte d'Ivoire, Togo, Guinea-Conakry and Burkina Faso). Optical microscopy and/or direct immunofluorescence techniques were used. All biopsy samples including epidemiological, clinical and pathological data and an optical microscopy and/or direct immunofluorescence study were included. The parameters studied were indications for KB, epidemiological profile, clinic, proteinuria and pathological aspects.

Results

Over the study period, we collected 179 KB, i.e. 35.8 KB/year. The mean age of the patients was 32.9 ±13.8 years (range 11-70 years). The sex ratio (M/F) was 1.03. Pure nephrotic syndrome was the main indication (64.2 %, n = 115) for KB, followed by impure nephrotic syndrome (11.7 %, n = 21), acute renal failure (ARF) (7.8 %, n = 14) and rapidly progressive glomerulonephritis (RPGN) (7.8 %, n = 14). Glomerulonephritis (GN) occurred in 86 % (n = 158), vascular nephropathy in 11.7 % (n = 21) and tubulointerstitial nephritis in 2.2 % (n = 4). The nephropathies were preferentially focal segmental glomerulosclerosis (34.6 %, n = 62), nephroangiosclerosis (10.6 %, n = 19), membranous GN (10 %, n = 18), post-infectious GN (8.9 %, n = 16) and lupus GN (7.3 %, n = 13).

Conclusion

The KB is an essential step in the diagnosis of nephropathies. Focal segmental glomerulosclerosis is frequent in our study. The establishment of a Kidney registry would allow better knowledge of renal pathologies in sub-Saharan Africa.

[Clinical and molecular characteristics of Streptococcus pneumoniae-associated hemophagocytic lymphohistiocytosis in children]

Objective: To summarize the clinical features of Streptococcus pneumoniae-associated hemophagocytic syndrome (SP-HLH), and the serotypes and drug-resistant characteristics of the isolated strains. Methods: There were 15 children with SP-HLH admitted to the Pediatric Intensive Care Unit (PICU) of Beijing Children's Hospital, Capital Medical University from January 2013 to December 2020 were included in this study. Clinical data including children's general characteristics, clinical features, laboratory examinations, treatments, prognosis and the outcomes of follow-up by May 2021 were analyzed retrospectively. The serotypes and drug resistance of the isolated strains were identified. All children were divided into the clinical improvement group and the death group. Mann-Whitney U test, Fisher's exact test were used to compare the data of the two groups. Results: Among the 15 children with SP-HLH, 8 were males and 7 were females. The age of these children was 1.0 (1.0, 2.5) years. Regarding the primary infection, there were 9 cases of severe pneumonia, 3 cases of meningitis and 3 cases of blood stream infection. None of these children had received pneumoniae conjugate vaccine (PCV) and all of them were admitted to the PICU. Respiratory failure was observed in 10 patients, acute renal injury in 5, and hemolytic uremic syndrome in 3 patients. All children received glucocorticoids and high-dose intravenous immunogloblin (IVIG) in addition to anti-infective treatment. Eight of the children were cured while the other 7 died. The neutrophil count in the death group was lower than that in the clinical improvement group ((5.0 (1.7, 9.3) × 10⁹ vs. 5.2 (3.4, 10.5) ×10⁹/L, Z =-2.43, P<0.015), and the length of hospital stay and days of PICU stay in the death group were both shorter than those in the improvement group statistically (3 (1, 11) vs. 39 (34, 48) d, 2 (1, 4) vs. 19 (12, 31) d, Z=-3.25, -3.24, both P=0.001). Ten serotypes of Streptococcus pneumoniae were identified, including 4 strains of 19F, 3 of 19A, 1 of 23F, 1 of 15A and 1 of 14, among which 9 strains (9/10) were covered by PCV13. All strains were resistant to erythromycin yet sensitive to vancomycin and linezolid. Conclusions: SP-HLH is more common in children under the age of 3, with a high mortality rate. The death cases have lower neutrophil count and rapid disease progression. The comprehensive treatment is anti-infective combined with glucocorticoids and high-dose IVIG. The predominant serotypes are 19F and 19A and all isolated strains were susceptible to vancomycin and linezolid.

[The origin of the name "100-day cough"]

Many studies in modern times claim that the name " 100-day cough" is from traditional Chinese medicine, and even think that there is a description of pertussis as early as the Sui Dynasty classics. By reviewing the original texts of the classics, we found that these interpretations are not exactly. The description of the pertussis and the chronological distribution of the literature in traditional Chinese books are similar to those of Western medicine. They started about 500 years ago, and then become more detailed and specific. The domestic medical community has a variety of nomenclature for this disease, and there is no sign or evidence to uniformly use "100-day cough" as the disease name. The literature records suggest that "100-day cough" first became a more recognized disease name in Japan, and through the direct input of medical education, entered the modern medical textbooks of western medicine in China.

[Guidelines for the use of post-traumatic tetanus vaccines and passive immune preparation]

Post-traumatic tetanus is the main type of non-neonatal tetanus. To reduce the incidence and mortality rateof tetanus and guide the primary medical institutions to prevent and control tetanus after trauma, the National Immunization Planning Technical Working Group of the Chinese Center for Disease Control and Prevention has compiled this document in the reference with Position Paper by World Health Organization, and the latest research progress both at home and abroad. The guidelines focus on the basic procedures for the prevention and treatment of post-traumatic tetanus, the application of tetanus vaccines and immune preparation, and pre-exposure immunization in high-risk populations of trauma.

[Guidelines for the use of post-traumatic tetanus vaccines and passive immune preparation]

Post-traumatic tetanus is the main type of non-neonatal tetanus. To reduce the incidence and mortality rate of tetanus and guide the primary medical institutions to prevent and control tetanus after trauma, National Immunization Planning Technical Working Group of the Chinese Center for Disease Control and Prevention has compiled this document in the reference with Position Paper by World Health Organization, the latest research progress from home and abroad. The guidelines focus on the basic procedures for the prevention and disposition of post-traumatic tetanus, the application of tetanus vaccines and immune preparation, and the pre-exposure immunization in high-risk populations of trauma.

[Serotype distribution and drug resistance of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis isolated from nasopharynx of Uygur children]

Objective: To investigate the serotype distribution and antimicrobial susceptibility pattern of Streptococcus pneumoniae (S. pneumoniae), Haemophilus influenzae (H. influenzae) and Moraxella catarrhalis (M. catarrhalis) isolates collected from nasopharyngeal swabs from Uygur children in Kashi. Methods: Nasopharyngeal swabs were collected from inpatient Uygur children aged from 1 month to 5 years with respiratory infections from the pediatric department, the First People's Hospital of Kashi, Xinjiang Uygur Autonomous Region. Antimicrobial susceptibilities of the isolates were determined with E-test and KB disk diffusion methods. The production of β-lactamase was detected for H. influenzae and M. catarrhalisisolates using nitrocefin disc method. Quellung test and latex agglutination test were adopted to identify serotypes of S. pneumoniae and H. influenzae isolates. Results: Forty-seven S. pneumoniae, 13 H. influenzae and 16 M. catarrhalis isolates were detected. All of the 47 S. pneumoniae isolates were sensitive to parenteral penicillin, amoxicillin-clavulanic acid, vancomycin and levofloxacin; the susceptibility rates to cefotaxime, imipenem and chloramphenicol were 94% (44/47), 89% (42/47), and 98% (46/47). The resistance rate to erythromycin was 74% (35/47). The most common serotype of S. pneumoniae was serotype 19A (10 strains, 21%). The coverage rate of 13-valent conjugate vaccine (PCV13) was 70% (33/47). None of the 13 H. influenzae isolates could be typed. They were highly susceptible to tested β-lactams antibiotics, except ampicillin. Only one H. influenzae isolate could produce β-lactamase, and two isolates were identified as β-lactamase-negative-ampicillin-resistant ones. The sixteen M. catarrhalis isolates were all positive in β-lactamase detection, but sensitive to amoxicillin-clavulanic acid, cephalosporins and meropenem. Conclusions: In Kashi, Xinjiang Uygur Autonmous Region, S. pneumoniae isolates from Uygur children were highly sensitive to parenteral penicillin and other β-lactams antibiotics. H. influenzae isolates from Uygur children were highly susceptible to amoxicillin-clavulanic acid, cephalosporins and ciprofloxacin. All M. catarrhalis isolates from Uygur children could produce β-lactamase, but were sensitive to the enzyme inhibitors and cephalosporins.

[Clinical, biological, therapeutic and evolving profile of patients with HIV infection hospitalized at Infectious and tropical diseases unit in Abidjan (Ivory Coast)]

The objective of this study is to describe the clinical, biological, therapeutic and evolving current profile of hospitalized patients with HIV infection in the cohort of the Infectious and Tropical Diseases Unit (ITDU) in the aim to improve their care management. This is a retrospective study, conducted on medical data of hospitalized cases of patients with HIV infection in the ITDU at the teaching hospital of Treichville (Abidjan) from 2006 to 2007. During the two years, 447 patients were included in the study. Their average age was 39 years [18 years-86 years] and sex ratio was 0.69. Of the 447 patients, 35% were unemployed and 67% were new patients who had never undergone antiretroviral therapy (ART). The duration of drug exposure was less than 6 months in 59% of treated patients. The average time to initiate ART was seven weeks. Among naive patients 41.9% were lost to follow up, 35.9% were waiting for treatment and 22.1% waiting for baseline biological test to initiate ART. At the initiation of ART, 79.6% of patients had a CD4 count less than 200/mm(3). The reasons of hospitalization defining AIDS were dominated by tuberculosis (34.2%), cerebral toxoplasmosis (17.9%) and neuromeningeal cryptococcosis (8%). The main reasons of hospitalization in classifying non-AIDS were pyelonephritis (6.5%), bacterial pneumonia (5.4%) and undetermined infectious encephalitis (4.9%). Hospital mortality was 24.4%. The leading causes of death were tuberculosis (22.9%), cerebral toxoplasmosis (20.2%), undetermined infectious encephalitis (18.3%) and cryptococcal meningitis (13.7%). The profile of PLHIV in hospital is characterized by profound immunosuppression due to late diagnosis and high mortality associated with severe opportunistic infections and late initiation of ART.

Resistance of Haemophilus influenzae isolates in children under 5 years old with acute respiratory infections in China between 2000 and 2002

This prospective, three-centre study tested for antimicrobial susceptibility in 898 isolates of Haemophilus influenzae between 2000 and 2002 in Chinese children aged under 5 years with acute upper respiratory tract infection. The average incidence of beta-lactamase production was 12.0%. Overall, 88.0% of isolates were susceptible to ampicillin, 100.0% were susceptible to amoxicillin/clavulanic acid, ceftriaxone, cefuroxime and azithromycin, and 99.0% were susceptible to ciprofloxacin. Isolates from Beijing and Shanghai had a lower susceptibility to tetracycline (57.0% and 61.0%, respectively) compared with those from Guangzhou (81.0%), while trimethoprim/sulfamethoxazole susceptibilities in Shanghai (47.0%) and Guangzhou (54.0%) were significantly higher than in Beijing (35.0%). A total of 34.5% of all the isolates were susceptible to all eight of these antimicrobial agents and 12.8% were multi-drug resistant. Ampicillin resistance increased over the duration of the study. These findings show that beta-lactamase production and ampicillin resistance among isolates from Chinese children with upper respiratory tract infection are increasing, and highlight the strong correlation between ampicillin resistance and resistance to cefaclor, chloramphenicol and tetracycline in H. influenzae isolates.