Gomez Carolina A, Gonzales Brayan E, Hernández Roger A, Campos Francisco, Chaparro Eduardo, Del Águila Olguita, Castillo María E, Saenz Andrés, Reyes Isabel, Ochoa Theresa J
Facultad de Medicina Humana «Alberto Hurtado», Universidad Peruana Cayetano Heredia, Lima, Perú.
Instituto de Medicina Tropical «Alexander von Humboldt», Universidad Peruana Cayetano Heredia, Lima, Perú.
Rev Peru Med Exp Salud Publica. 2025 Jun 9;42(1):63-69. doi: 10.17843/rpmesp.2025.421.13847.
The clinical and microbiological characteristics of pneumococcal pneumonia in children hospitalized in Lima were analyzed, before and after the introduction of pneumococcal conjugate vaccines (PCV). We reviewed cases that occurred between 2006-2019, in the pre-PCV7 (2006-2008), post-PCV7 (2009-2011) and post-PCV13 (2016-2019) periods. Of 128 patients with positive cultures (92 blood and 36 pleural fluid), most were infants in the pre-PCV7 (77.1%) and post-PCV7 (43.3%) studies, while in the post-PCV13 study they were mostly preschoolers (62%). We found an increase in complicated pneumonia cases from 14.6% to 72% and an increase in serotype 19A (6.3% to 68%). The most frequent sequence type was ST320 (31 isolates). Resistance to penicillin and ceftriaxone was low (6% and 2%, respectively), although higher in empyema (21.4% and 14.3%, respectively). Resistance to azithromycin increased from 27% to 92%. Penicillin remains the antibiotic of choice for the treatment of uncomplicated pneumococcal pneumonia in Lima. Motivation for the study. Although studies on invasive pneumococcal disease have been conducted in Lima, the characteristics of pneumococcal pneumonia before and after the introduction of pneumococcal conjugate vaccines are unknown. Main findings. We found an increase in complicated pneumococcal pneumonia cases, particularly empyema and an increase in serotype 19A. Resistance to penicillin and ceftriaxone was found to be low; however, in cases of empyema, antibiotic resistance was higher. Public health implications. Penicillin or amoxicillin should continue to be prescribed for the empirical management of pneumococcal pneumonia; however, ceftriaxone is recommended for cases with empyema. Continued local monitoring of pneumococcal resistance and serotypes is recommended.
分析了利马住院儿童肺炎球菌肺炎在引入肺炎球菌结合疫苗（PCV）前后的临床和微生物学特征。我们回顾了2006年至2019年期间在PCV7之前（2006 - 2008年）、PCV7之后（2009 - 2011年）和PCV13之后（2016 - 2019年）发生的病例。在128例培养阳性的患者中（92例血液培养阳性和36例胸腔积液培养阳性），在PCV7之前（77.1%）和PCV7之后（43.3%）的研究中，大多数是婴儿，而在PCV13之后的研究中，大多数是学龄前儿童（62%）。我们发现复杂肺炎病例从14.6%增加到72%，19A血清型增加（从6.3%增加到68%）。最常见的序列类型是ST320（31株分离株）。对青霉素和头孢曲松的耐药性较低（分别为6%和2%），尽管在脓胸患者中较高（分别为21.4%和14.3%）。对阿奇霉素的耐药性从27%增加到92%。青霉素仍然是利马治疗非复杂性肺炎球菌肺炎的首选抗生素。研究动机。尽管在利马已经开展了关于侵袭性肺炎球菌疾病的研究，但引入肺炎球菌结合疫苗前后肺炎球菌肺炎的特征尚不清楚。主要发现。我们发现复杂肺炎球菌肺炎病例增加，尤其是脓胸，以及19A血清型增加。发现对青霉素和头孢曲松的耐药性较低；然而，在脓胸病例中，抗生素耐药性较高。对公共卫生的影响。青霉素或阿莫西林应继续用于肺炎球菌肺炎的经验性治疗；然而，对于脓胸病例，推荐使用头孢曲松。建议持续对肺炎球菌耐药性和血清型进行本地监测。
