Community acquired pneumonia among pediatric outpatients in Salvador, Northeast Brazil, with emphasis on the role of pneumococcus

Abstract

Pneumonia is one of the leading causes of hospitalization and death among children in developing countries, and mortality due to pneumonia has been associated with S. pneumoniae infection. This investigation was designed to describe the antimicrobial susceptibility and serotype patterns of pneumococcal strains recovered from the blood of children with community-acquired pneumonia (CAP) and to assess the clinical findings of pneumococcal bacteremic patients with pneumonia. In a 26 month prospective study, blood cultures were obtained as often as possible from children (<16 years of age) diagnosed with CAP in two emergency rooms. Antimicrobial drug susceptibility tests and serotyping were performed when pneumococcus was identified. We studied 3,431 cases and cultured blood samples from 65.5% of those. Pneumococcus was recovered from 0.8% of the blood samples. The differences in age, somnolence, wheezing and hospitalization among children with and without pneumococcal bacteremia were statistically significant. Pneumococcal bacteremia was age-related (mean 1.63 +/- 1.55; median 0.92) and associated with somnolence and hospitalization among children with CAP. One strain was recovered from pleural fluid. Penicillin resistance was detected in 21.0% (4/19) of the strains at an intermediate level, whereas 63.0% of the strains were resistant to trimethoprim-sulfamethoxazole. The most common serotypes were 14 and 6B, and these serotypes included the resistant strains. Eight of our 18 isolates from blood were of types included in the heptavalent conjugate pneumococcal vaccine, recently licensed in the USA.

Epidemiology of community-acquired pneumonia in children of Latin America and the Caribbean: a systematic review and meta-analysis

“…Sixty references (69 studies), relating to a total 23 854 episodes of CAP in children aged less than 5 years, were included in this systematic review. The studies were conducted between 1980 and 2007 in Brazil (n = 17), [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] Argentina (n = 11) 11,22,[39][40][41][42][43][44][45] (also Ruvinsky R. Carga de neumonía consolidante en niñ os menores de 5 añ os en la ciudad de Concordia; personal communication), Uruguay (n = 10), 22,[46][47][48][49][50][51][52][53][54] Chile (n = 9), 22,[55][56][57][58][59][60][61][62] Colombia (n = 6), 22,[63][64]…”

“…Ten papers presented pertinent data on the various serotypes of S. pneumoniae as etiological agents of CAP in children aged less than 5 years (including Ruvinsky R. Carga de neumonía consolidante en niñ os menores de 5 añ os en la ciudad de Concordia; personal communication). 22,27,31,35,[43][44][45][46]52 Across studies, serotype 14 was the most common, varying from 31% to 55% of pneumococcal pneumonia cases, and showing a pooled prevalence of 33.00% (95% CI 25.95-40.45). Other less frequently associated serotypes were serotype 1 (10.96%; 95% CI 9.17-12.88) and serotype 5 (10.84%; 95% CI 7.3-14.99) (see Table 5).…”

“…This review found evidence in 25 published articles presenting data from Brazil, Argentina, Uruguay, Chile, Colombia, Venezuela, Mexico, and Ecuador. 11,24,28,31,32,36,44,47,49,50,[52][53][54][55]57,[62][63][64][65][69][70][71]73,76,78 These studies, conducted between 1986 and 2003, showed that 23-29.7% of CAP cases required hospitalization and that 3.2% required intensive care unit stays. 54 The median length of stay for patients admitted to general care was 11 days (range 5-13.5 days).…”

Pneumonia Comunitária em Crianças e Adolescentes em Salvador

“…Chamou a atenção o isolamento, em cultura pura, de S. viridans em cinco dospacientes (Nascimento-Carvalho et al, 2001c). Em adultos com pneumonia, S. viridans já foi isolado de tecido pulmonar por meio de toracocentese (Pratter & Irwin, 1980) e de aspiração transbrônquica (Lorch et al, 1987); também foi atribuído como agente causador da pneumonia ao ser isolado em duas amostras de hemocultura (Sarkar, Murarka & Gilardi, 1989) ou ser isolado na primeira subcultura (Mahomed et al, 1992).…”

Recomendação da Sociedade Brasileira de Pediatria para antibioticoterapia em crianças e adolescentes com pneumonia comunitária

“…Devido à freqüência de bactérias piogênicas com capacidade de invadir a corrente sangüínea entre as causas de pneumonia, a hemocultura continua sendo um método onde o material é de fácil obtenção e que possibilita o conhecimento do agente causal em cerca de 1 a 3% dos casos ambulatoriais (27,28,53) ou de 1 a 4,5% dos casos hospitalizados (49,54,55). A importância da hemocultura para fins diagnósticos, quando executada de acordo com as normas técnicas vigentes, tem sido defendida largamente (56-58), pelo menos para crianças com pneumonia que necessitem de tratamento hospitalar (55). Outro método importante para a investigação de etiologia bacteriana é a cultura do líquido pleural, passível de ser realizada quando há derrame, com maior sensibilidade quando realizada antes do início do tratamento antimicrobiano.…”