Pneumococcal acute otitis media in infants and children in central Romania, 2009-2011: Microbiological characteristics and potential coverage by pneumococcal conjugate vaccines

Department of Pediatrics, Children's Hospital, Faculty of Medicine, Transilvania University, Brasov, Romania.
International journal of infectious diseases: IJID: official publication of the International Society for Infectious Diseases (Impact Factor: 1.86). 03/2013; 17(9). DOI: 10.1016/j.ijid.2013.02.002
Source: PubMed


OBJECTIVE: To assess the epidemiological and microbiological characteristics of pneumococcal acute otitis media (AOM) in children in Brasov, Central Romania, before the introduction of pneumococcal conjugate vaccine (PCV) into the routine national immunization program. METHODS: All AOM patients aged <5 years who underwent tympanocentesis or presented with purulent otorrhea of ≤24h duration during 2009-2011 were enrolled. RESULTS: Two hundred and twelve consecutive AOM patients had a middle ear fluid (MEF) culture performed; 99 (46.6%) episodes occurred in patients <12 months of age. One hundred and eleven (52.4%) episodes were culture-positive. Tympanocentesis was performed in 142 patients and spontaneous otorrhea cultures in 70 patients. Overall, 114 pathogens were recovered: Streptococcus pneumoniae was the most common isolate (81 isolates, 70.3% of all culture-positive episodes), followed by non-typeable Haemophilus influenzae (26, 20.7%), Streptococcus pyogenes (5, 4.5%), and Moraxella catarrhalis (2, 1.8%). Antibiotic susceptibility and serotyping were performed for 48 (59.3%) S. pneumoniae isolates: 45 (93.8%) were non-susceptible to penicillin (minimal inhibitory concentration (MIC) ≥2.0μg/ml in 24, 53.3%) and 37 (77.1%) isolates had ceftriaxone MIC values ≥0.5μg/ml (16 with MIC >2.0μg/ml). S. pneumoniae non-susceptibility rates to trimethoprim-sulfamethoxazole, erythromycin, and clindamycin were 75.0%, 58.3%, and 35.4%, respectively. All isolates were susceptible to chloramphenicol. Multidrug resistance was found in 33 (68.7%) isolates. The most common S. pneumoniae serotypes were 19F (14, 29.2%), 6B (8, 16.7%), 23F (8, 16.7%), and 14 (6, 12.5%). Serotype 19A was found in three (6.2%) patients and 6A in two (4.1%). Non-PCV13 serotypes represented six (12.6%) of all serotypes (four of them non-susceptible to penicillin). Thirty-six (75.0%) isolates were potentially covered by PCV7, 37 (77.0%) by PCV10, and 42 (87.5%) by PCV13. CONCLUSIONS: (1) S. pneumoniae was the most prevalent pathogen, with frequent antibiotic resistance and multi-resistance patterns; (2) most pneumococcal AOM and multidrug-resistant episodes could be prevented by PCVs.

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    ABSTRACT: Background: We aimed to describe bacterial etiology of acute otitis media (AOM) and characterize resistance, serotypes and genotype profiles of AOM-causing pneumococci recovered in Moscow children. Methods: Children with AOM and an available middle ear fluid specimen were prospectively enrolled in this study. Streptococcus pneumoniae, Streptococcus pyogenes, Haemophilus influenzae and Moraxella catarrhalis were considered as true otopathogens. All pneumococcal isolates were serotyped using the Quellung reaction; multidrug-resistant (MDR) pneumococci underwent multilocus sequence typing. Results: In 172 of 541 enrolled AOM patients (32%) at least 1 otopathogen was recovered, with S. pneumoniae having the highest rate of 63% (109/172). When adjusted for antibiotic treatment before sampling, in untreated patients the rate of culture-positive AOM was 35% (124/352), S. pneumoniae had a prevalence of 69% (86/124), S. pyogenes 19% (24/124), H. influenzae 13% (16/124) and M. catarrhalis 9% (11/124). Among 107 examined pneumococci, 45% were penicillin-nonsusceptible, 34 and 30% were resistant to erythromycin and clindamycin, respectively; 30% had an MDR phenotype, but no amoxicillin-resistant isolates were found. Ten of 32 (31%) MDR pneumococci related to clonal complex 320, the remaining isolates belonged to 7 different clonal complex. Six leading serotypes were 19F (27%), 3 (12%), 6B (11%), 14 (11%), 19A (9%) and 23F (8%); overall polysaccharide conjugate vaccine13 coverage was 93%. Conclusions: S. pneumoniae, the leading bacterial AOM pathogen in Moscow children, is characterized by a substantial rate of antibiotic nonsusceptibility and clonality. A polysaccharide conjugate vaccine with expanded coverage seems to fit the current AOM pneumococcal serotype distribution in Russia better.
    The Pediatric Infectious Disease Journal 09/2014; 34(3). DOI:10.1097/INF.0000000000000554 · 2.72 Impact Factor
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    ABSTRACT: Objectives/HypothesisAcute otitis media (AOM) is a common bacterial infection in childhood that causes an inflammatory response in the middle ear. Leukocytes produce different inflammatory molecules in vitro when stimulated with Gram-positive and Gram-negative bacteria. The major causes of AOM are Streptococcus pneumoniae, nontypeable Haemophilus influenza, and Moraxella catarrhalis. We sought to assess differences in cytokines, chemokines, and expression of Toll-like receptors (TLRs) at onset of AOM based on bacterial culture results.Study DesignMiddle ear fluid (MEF) from 66 children with AOM was studied.Methods Innate immune genes, cytokines (interleukin [IL]-6, IL-8, IL-10, IL1-β; tumor necrosis factor-α), chemokines (CCL2, CCL3, CCL4, CCR5, CXCR3), and Toll-like receptors (TLR2, TLR4, TLR9) expression was measured using real-time reverse transcriptase-polymerase chain reaction (RT-PCR) from MEF collected in vivo by tympanocentesis.ResultsCulture-positive MEF had higher levels of all cytokines and chemokines (9–300-fold) as compared to MEF that was culture negative. Polymerase chain reaction (PCR)-positive/culture-negative MEF for otopathogens showed significant differences (P < .01) in TLR2, TLR4, and TLR9 expression (6–31-fold), but cytokine and chemokine levels were similar compared to PCR-negative/culture-negative MEF. No significant differences were found in the cytokine/chemokine/TLR levels among the bacterial otopathogen species. However, higher levels of TLRs, and all the cytokine and chemokines were detected when more than one bacterial species was present compared to single otopathogens.Conclusions Expression levels of proinflammatory cytokines/chemokines and TLRs are elevated in AOM children with a bacterial otopathogen, and are dependent on the number of bacterial species identified.Level of EvidenceNA Laryngoscope, 2014
    The Laryngoscope 01/2015; 125(1). DOI:10.1002/lary.24920 · 2.14 Impact Factor

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