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Pathogens implicated in acute otitis media failures after 7-valent pneumococcal conjugate vaccine implementation in France: distribution, serotypes, and resistance levels.
Pediatr Infect Dis J 2012; 31(2):154-8PI

Abstract

BACKGROUND

Before 7-valent pneumococcal conjugate vaccine (PCV7) implementation in France, several studies had described the microbiology of acute otitis media (AOM) treatment failures. The causative pathogens were Streptococcus pneumoniae (Sp) followed by nontypable Haemophilus influenzae (NTHi). The aim of this study was to describe the epidemiology of pathogens involved in AOM treatment failures or recurrences.

METHODS

This French multicentric prospective study enrolled 143 children with AOM treatment failure between 2007 and 2009 observed by 8 ear, nose, and throat specialists. Failure was defined as the persistence of AOM symptoms after at least 48 hours of antibiotic therapy or their recurrence within 4 days after the end of treatment. Standardized history and physical examination findings were recorded, and culture of middle ear fluid (MEF) was obtained.

RESULTS

Mean age was 16.9 ± 9.9 months (median, 13.7). Eighty-eight percent of children had received more than 1 dose of PCV7, and 70.6% attended day care. The most common antibiotic used at the time of treatment failure or recurrence was a combination of amoxicillin and clavulanate (51.1%). Bacteriologic sampling demonstrated that in 35% of cases (n=50), no otopathogen was cultured at the time of treatment failure or recurrence. Similar proportions of Sp and NTHi were observed in the 86 patients (60.1%) from whom only a single species was recovered from MEF (46.5% for Sp, n=40 and 45.3% for NTHi, n=39). Among Sp strains, 4.4% were penicillin susceptible, 77.8% were penicillin intermediate, and 17.8% were fully penicillin resistant, and serotype 19A represented 84.5% of all serotypes detected. Among NTHi isolates, 15.5% (n=7) were β-lactamase-producing strains (including 2 strains with only this mechanism of resistance), and strains with reduced susceptibility by changes in protein binding to penicillin (β-lactamase-negative ampicillin resistant strains) represented 35.5% of cases. Among the 50 sterile MEF samples, polymerase chain reaction was performed in 32, of which 4 were positive for HI, 3 for Sp, and 3 for both.

CONCLUSIONS

Among children with AOM treatment failures in France, Sp and NTHi were equally distributed; 19A was the main Sp serotype, and the main resistance mechanism for NTHi was β-lactamase-negative ampicillin resistance.

Authors+Show Affiliations

Service d'ORL Pédiatrique, Necker Hospital, AP-HP, Université Paris 5, Paris, France.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21983212

Citation

Couloigner, Vincent, et al. "Pathogens Implicated in Acute Otitis Media Failures After 7-valent Pneumococcal Conjugate Vaccine Implementation in France: Distribution, Serotypes, and Resistance Levels." The Pediatric Infectious Disease Journal, vol. 31, no. 2, 2012, pp. 154-8.
Couloigner V, Levy C, François M, et al. Pathogens implicated in acute otitis media failures after 7-valent pneumococcal conjugate vaccine implementation in France: distribution, serotypes, and resistance levels. Pediatr Infect Dis J. 2012;31(2):154-8.
Couloigner, V., Levy, C., François, M., Bidet, P., Hausdorff, W. P., Pascal, T., ... Cohen, R. (2012). Pathogens implicated in acute otitis media failures after 7-valent pneumococcal conjugate vaccine implementation in France: distribution, serotypes, and resistance levels. The Pediatric Infectious Disease Journal, 31(2), pp. 154-8. doi:10.1097/INF.0b013e3182357c8d.
Couloigner V, et al. Pathogens Implicated in Acute Otitis Media Failures After 7-valent Pneumococcal Conjugate Vaccine Implementation in France: Distribution, Serotypes, and Resistance Levels. Pediatr Infect Dis J. 2012;31(2):154-8. PubMed PMID: 21983212.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pathogens implicated in acute otitis media failures after 7-valent pneumococcal conjugate vaccine implementation in France: distribution, serotypes, and resistance levels. AU - Couloigner,Vincent, AU - Levy,Corinne, AU - François,Martine, AU - Bidet,Philippe, AU - Hausdorff,William P, AU - Pascal,Thierry, AU - Boucherat,Michel, AU - Bingen,Edouard, AU - Mariani,Patricia, AU - Pierrot,Sébastien, AU - Bille,Emmanuelle, AU - Carbonnelle,Etienne, AU - Varon,Emmanuelle, AU - Cohen,Robert, PY - 2011/10/11/entrez PY - 2011/10/11/pubmed PY - 2012/5/12/medline SP - 154 EP - 8 JF - The Pediatric infectious disease journal JO - Pediatr. Infect. Dis. J. VL - 31 IS - 2 N2 - BACKGROUND: Before 7-valent pneumococcal conjugate vaccine (PCV7) implementation in France, several studies had described the microbiology of acute otitis media (AOM) treatment failures. The causative pathogens were Streptococcus pneumoniae (Sp) followed by nontypable Haemophilus influenzae (NTHi). The aim of this study was to describe the epidemiology of pathogens involved in AOM treatment failures or recurrences. METHODS: This French multicentric prospective study enrolled 143 children with AOM treatment failure between 2007 and 2009 observed by 8 ear, nose, and throat specialists. Failure was defined as the persistence of AOM symptoms after at least 48 hours of antibiotic therapy or their recurrence within 4 days after the end of treatment. Standardized history and physical examination findings were recorded, and culture of middle ear fluid (MEF) was obtained. RESULTS: Mean age was 16.9 ± 9.9 months (median, 13.7). Eighty-eight percent of children had received more than 1 dose of PCV7, and 70.6% attended day care. The most common antibiotic used at the time of treatment failure or recurrence was a combination of amoxicillin and clavulanate (51.1%). Bacteriologic sampling demonstrated that in 35% of cases (n=50), no otopathogen was cultured at the time of treatment failure or recurrence. Similar proportions of Sp and NTHi were observed in the 86 patients (60.1%) from whom only a single species was recovered from MEF (46.5% for Sp, n=40 and 45.3% for NTHi, n=39). Among Sp strains, 4.4% were penicillin susceptible, 77.8% were penicillin intermediate, and 17.8% were fully penicillin resistant, and serotype 19A represented 84.5% of all serotypes detected. Among NTHi isolates, 15.5% (n=7) were β-lactamase-producing strains (including 2 strains with only this mechanism of resistance), and strains with reduced susceptibility by changes in protein binding to penicillin (β-lactamase-negative ampicillin resistant strains) represented 35.5% of cases. Among the 50 sterile MEF samples, polymerase chain reaction was performed in 32, of which 4 were positive for HI, 3 for Sp, and 3 for both. CONCLUSIONS: Among children with AOM treatment failures in France, Sp and NTHi were equally distributed; 19A was the main Sp serotype, and the main resistance mechanism for NTHi was β-lactamase-negative ampicillin resistance. SN - 1532-0987 UR - https://www.unboundmedicine.com/medline/citation/21983212/Pathogens_implicated_in_acute_otitis_media_failures_after_7_valent_pneumococcal_conjugate_vaccine_implementation_in_France:_distribution_serotypes_and_resistance_levels_ L2 - http://Insights.ovid.com/pubmed?pmid=21983212 DB - PRIME DP - Unbound Medicine ER -