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Pneumococcal infection in hospitalized patients: a four-year study in Malaysia
1National Streptococcus Reference Laboratory, Faculty of Medicine, National University of Malaysia, Kuala Lumpur.
Abstract:
A total of 90 cases of pneumococcal infections were identified at a major referral hospital in Kuala Lumpur, Malaysia during a study period of four years. Pneumonia was the most common clinical presentation (41 cases) followed by meningitis (19 cases). Of 48 patients who were followed-up during the microbiology consultation round, 11 died, 9 were children below two years old. Capsular typing was carried out on 57 strains of Streptococcus pneumoniae isolated from blood and body fluids of 43 children and 14 adults. 38 strains isolated from pharyngeal specimens were also typed. Types 6A (11 strains), 6B (7 strains), 14 (8 strains) and 19A (8 strains) predominated in children. The strains from older patients comprised 3 isolates from cerebrospinal fluid (types 18B, 6B and 14), five from blood (4 strains, type 1 and 1 strain, type 4) and six from pus (1 strain, type 14, 3 strains type 23F and 2 strains type 34). The isolates from pharyngeal specimens belonged to capsular type similar to those implicated in infections. 90% of the types reported in this study are included in the 23 valent pneumococcal vaccines. Minimum inhibitory concentrations of penicillin, cefuroxime, chloramphenicol and rifampicin were determined for selected strains. 4.1% of isolates were resistant to penicillin (3/74), 4.5% to cefuroxime (2/44), 6.5% to chloramphenicol (3/46) and 14.6% to rifampicin (6/41).
Insights
Pneumococcal infections, primarily pneumonia and meningitis, were studied in Malaysia. Predominant Streptococcus pneumoniae serotypes in children are covered by the 23-valent pneumococcal vaccine, though some antibiotic resistance was noted.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Epidemiology
Background:
- Pneumococcal infections pose a significant public health challenge globally.
- Streptococcus pneumoniae is a leading cause of bacterial pneumonia, meningitis, and sepsis.
- Understanding serotype distribution and antimicrobial resistance is crucial for effective prevention and treatment strategies.
Purpose of the Study:
- To characterize the epidemiology of pneumococcal infections in Kuala Lumpur, Malaysia.
- To identify common Streptococcus pneumoniae serotypes causing infections in children and adults.
- To assess antimicrobial resistance patterns of isolated strains.
Main Methods:
- Retrospective analysis of 90 pneumococcal infection cases over four years.
- Capsular typing of Streptococcus pneumoniae strains from clinical isolates and pharyngeal specimens.
- Determination of minimum inhibitory concentrations (MICs) for selected antibiotics.
Main Results:
- Pneumonia (41 cases) and meningitis (19 cases) were the most frequent presentations.
- Predominant serotypes in children included 6A, 6B, 14, and 19A.
- Antibiotic resistance observed: 4.1% to penicillin, 4.5% to cefuroxime, 6.5% to chloramphenicol, and 14.6% to rifampicin.
- 90% of identified serotypes are included in the 23-valent pneumococcal vaccine.
Conclusions:
- The study highlights the burden of pneumococcal infections and identifies key serotypes circulating in Malaysia.
- The 23-valent pneumococcal vaccine likely covers a significant proportion of circulating strains in children.
- Emerging antimicrobial resistance warrants continued surveillance and consideration in treatment guidelines.