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Invasive pneumococcal disease caused by ceftriaxone-resistant Streptococcus pneumoniae in Taiwan
Hao-Yuan Lee1, Tsu-Lan Wu2, Lin-Hui Su3
1Department of Nursing, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan; Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan.
Background:
Invasive pneumococcal disease (IPD) was associated with mortality, but the risk factors associated with mortality remains controversial.
Methods:
A retrospective cohort study was designed. All patients with IPD from 2011 to 2013 admitted in a medical center were screened and collected for their clinical presentations and laboratory characteristics.
Results:
Approximately half of the 134 IPD isolates derived from these patients belonged to three major serotypes (19A, 6A and 3), which are included in 13-valent pneumococcal conjugate vaccine (PCV13), but not in 7-valent pneumococcal conjugate vaccine (PCV7). Ceftriaxone resistance according to non-meningitis criteria was identified in 38% of the IPD isolates, and was the major independent risk factor associated with inappropriate initial therapy that subsequently contributed to mortality of the patients. Infection by serotype 6A, 15B, 19A, 19F, or 23F was the major independent risk factor associated with ceftriaxone resistance (non-meningitis criteria). 77.6% of these isolates belonged to additional PCV13 serotypes, with more than 40% expressing resistance to ceftriaxone. In terms of serotype coverage, PCV13 covered 94.1% of the IPD isolates with ceftriaxone resistance, in comparison to 21.6% only by PCV7.
Conclusions:
The increase of ceftriaxone resistance in pneumococci in part driven by PCV7 vaccination in Taiwan is worrisome. The use of PCV13 in children as well as in the elderly population is likely to offer protection from the infection caused by ceftriaxone-resistant pneumococci. It is important to give an effective drug such as penicillin, fluoroquinolones or vancomycin in 2 days for improving outcome of IPD patients.
Insights
Invasive pneumococcal disease (IPD) mortality risk factors are complex. Ceftriaxone resistance in pneumococci, particularly from PCV7-excluded serotypes, is a significant concern, highlighting PCV13
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Vaccinology
Background:
- Invasive pneumococcal disease (IPD) is a significant cause of mortality.
- Risk factors contributing to IPD mortality remain incompletely understood.
- Understanding serotype distribution and antimicrobial resistance is crucial for effective IPD management.
Purpose of the Study:
- To investigate the risk factors associated with mortality in patients with invasive pneumococcal disease.
- To analyze the serotype distribution and antimicrobial resistance patterns of IPD isolates.
- To evaluate the potential impact of pneumococcal conjugate vaccines (PCVs) on IPD outcomes.
Main Methods:
- A retrospective cohort study design was employed.
- Clinical presentations and laboratory characteristics of 134 IPD patients from 2011-2013 were collected.
- Serotype analysis and ceftriaxone resistance testing were performed on IPD isolates.
Main Results:
- Half of the IPD isolates belonged to serotypes 19A, 6A, and 3, covered by PCV13 but not PCV7.
- Ceftriaxone resistance was observed in 38% of isolates and was linked to inappropriate initial therapy and mortality.
- Serotypes 6A, 15B, 19A, 19F, and 23F were associated with ceftriaxone resistance; PCV13 covered 94.1% of these resistant isolates, compared to 21.6% for PCV7.
Conclusions:
- Increased ceftriaxone resistance in pneumococci, potentially driven by PCV7, is a concern.
- The 13-valent pneumococcal conjugate vaccine (PCV13) is likely to provide protection against ceftriaxone-resistant strains in both children and the elderly.
- Prompt administration of effective antibiotics like penicillin, fluoroquinolones, or vancomycin is essential for improving IPD patient outcomes.
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