Oral #Lefamulin vs #Moxifloxacin for Early #Clinical Response Among #Adults With Community-Acquired Bacterial #Pneumonia – The LEAP 2 Randomized Clinical Trial (JAMA, abstract)

[Source: Journal of the American Medical Association, full page: (LINK). Abstract, edited.]

Original Investigation / September 27, 2019

Oral Lefamulin vs Moxifloxacin for Early Clinical Response Among Adults With Community-Acquired Bacterial PneumoniaThe LEAP 2 Randomized Clinical Trial

Elizabeth Alexander, MD, MSc 1; Lisa Goldberg, MS 1; Anita F. Das, PhD 2; et al. Gregory J. Moran, MD 3; Christian Sandrock, MD 4; Leanne B. Gasink, MD 1; Patricia Spera, PhD 1; Carolyn Sweeney, BS 1; Susanne Paukner, PhD 5; Wolfgang W. Wicha, MSc 5; Steven P. Gelone, PharmD 1; Jennifer Schranz, MD 1

Author Affiliations: 1 Nabriva Therapeutics US Inc, King of Prussia, Pennsylvania; 2 Das Consulting, Guerneville, California; 3 Olive View-UCLA Medical Center, Los Angeles, California; 4 University of California, Davis, School of Medicine, Sacramento; 5 Nabriva Therapeutics GmbH, Vienna, Austria

JAMA. 2019;322(17):1661-1671. doi:10.1001/jama.2019.15468

 

Key Points

  • Question   – Is 5-day oral lefamulin noninferior to 7-day oral moxifloxacin in the management of community-acquired bacterial pneumonia?
  • Findings  – In this randomized clinical trial that included 738 patients, the early clinical response at 96 hours (within a 24-hour window) after the first dose of study drug was 90.8% in the lefamulin group and 90.8% in the moxifloxacin group, a difference that met the noninferiority margin of 10%.
  • Meaning   – This study demonstrated the noninferiority of oral lefamulin to oral moxifloxacin for the treatment of community-acquired bacterial pneumonia.

 

Abstract

Importance  

New antibacterials are needed to treat community-acquired bacterial pneumonia (CABP) because of growing antibacterial resistance and safety concerns with standard care.

Objective  

To evaluate the efficacy and adverse events of a 5-day oral lefamulin regimen in patients with CABP.

Design, Setting, and Participants  

A phase 3, noninferiority randomized clinical trial conducted at 99 sites in 19 countries that included adults aged 18 years or older with a Pneumonia Outcomes Research Team (PORT) risk class of II, III, or IV; radiographically documented pneumonia; acute illness; 3 or more CABP symptoms; and 2 or more vital sign abnormalities. The first patient visit was on August 30, 2016, and patients were followed up for 30 days; the final follow-up visit was on January 2, 2018.

Interventions  

Patients were randomized 1:1 to receive oral lefamulin (600 mg every 12 hours for 5 days; n = 370) or moxifloxacin (400 mg every 24 hours for 7 days; n = 368).

Main Outcomes and Measures  

The US Food and Drug Administration (FDA) primary end point was early clinical response at 96 hours (within a 24-hour window) after the first dose of either study drug in the intent-to-treat (ITT) population (all randomized patients). Responders were defined as alive, showing improvement in 2 or more of the 4 CABP symptoms, having no worsening of any CABP symptoms, and not receiving any nonstudy antibacterial drug for current CABP episode. The European Medicines Agency coprimary end points (FDA secondary end points) were investigator assessment of clinical response at test of cure (5-10 days after last dose) in the modified ITT population and in the clinically evaluable population. The noninferiority margin was 10% for early clinical response and investigator assessment of clinical response.

Results  

Among 738 randomized patients (mean age, 57.5 years; 351 women [47.6%]; 360 had a PORT risk class of III or IV [48.8%]), 707 (95.8%) completed the trial. Early clinical response rates were 90.8% with lefamulin and 90.8% with moxifloxacin (difference, 0.1% [1-sided 97.5% CI, –4.4% to ∞]). Rates of investigator assessment of clinical response success were 87.5% with lefamulin and 89.1% with moxifloxacin in the modified ITT population (difference, –1.6% [1-sided 97.5% CI, –6.3% to ∞]) and 89.7% and 93.6%, respectively, in the clinically evaluable population (difference, –3.9% [1-sided 97.5% CI, –8.2% to ∞]) at test of cure. The most frequently reported treatment-emergent adverse events were gastrointestinal (diarrhea: 45/368 [12.2%] in lefamulin group and 4/368 [1.1%] in moxifloxacin group; nausea: 19/368 [5.2%] in lefamulin group and 7/368 [1.9%] in moxifloxacin group).

Conclusions and Relevance  

Among patients with CABP, 5-day oral lefamulin was noninferior to 7-day oral moxifloxacin with respect to early clinical response at 96 hours after first dose.

Trial Registrations  ClinicalTrials.gov Identifier: NCT02813694; European Clinical Trials Identifier: 2015-004782-92

Keywords: Antibiotics; Pneumonia; CAP; Lefamulin.

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#Childhood #pneumonia, #pleurisy and #lung function: a cohort study from the first to sixth decade of life (Thorax, abstract)

[Source: Thorax, full page: (LINK). Abstract, edited.]

Childhood pneumonia, pleurisy and lung function: a cohort study from the first to sixth decade of life

Jennifer L Perret1,2,3, Caroline J Lodge1, Adrian J Lowe1, David P Johns4, Bruce R Thompson5,6, Dinh S Bui1, Lyle C Gurrin1, Melanie C Matheson1, Christine F McDonald2,3, Richard Wood-Baker4, Cecilie Svanes7,8, Paul S Thomas9, Graham G Giles1,10,11, Anne B Chang12,13,14, Michael J Abramson11, E Haydn Walters1,4, Shyamali C Dharmage1 On behalf of TAHS investigators

Author affiliations: 1 Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia; 2 Department of Respiratory and Sleep Medicine, Austin Hospital, Melbourne, Victoria, Australia; 3 Institute for Breathing and Sleep (IBAS), Melbourne, Victoria, Australia; 4 NHMRC Centre of Research Excellence for Chronic Respiratory Disease‎, University of Tasmania, Hobart, Tasmania, Australia; 5 Department of Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia; 6 Department of Medicine, Monash University, Melbourne, Victoria, Australia; 7 Centre for International Health, University of Bergen, Bergen, Norway; 8 Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway; 9 Prince of Wales’ Hospital Clinical School and School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; 10 Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Victoria, Australia; 11 Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; 12 Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia; 13 Department of Respiratory Medicine, Queensland Children’s Hospital, Brisbane, Queensland, Australia; 14 Queensland University of Technology, Brisbane, Queensland, Australia

Correspondence to Dr Jennifer L Perret, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3010, Australia; jennifer.perret@unimelb.edu.au

 

Abstract

Introduction 

Adult spirometry following community-acquired childhood pneumonia has variably been reported as showing obstructive or non-obstructive deficits. We analysed associations between doctor-diagnosed childhood pneumonia/pleurisy and more comprehensive lung function in a middle-aged general population cohort born in 1961.

Methods 

Data were from the prospective population-based Tasmanian Longitudinal Health Study cohort. Analysed lung function was from ages 7 years (prebronchodilator spirometry only, n=7097), 45 years (postbronchodilator spirometry, carbon monoxide transfer factor and static lung volumes, n=1220) and 53 years (postbronchodilator spirometry and transfer factor, n=2485). Parent-recalled histories of doctor-diagnosed childhood pneumonia and/or pleurisy were recorded at age 7. Multivariable linear and logistic regression were used.

Results 

At age 7, compared with no episodes, childhood pneumonia/pleurisy-ever was associated with reduced FEV1:FVC for only those with current asthma (beta-coefficient or change in z-score=−0.20 SD, 95% CI −0.38 to –0.02, p=0.028, p interaction=0.036). At age 45, for all participants, childhood pneumonia/pleurisy-ever was associated with a restrictive pattern: OR 3.02 (1.5 to 6.0), p=0.002 for spirometric restriction (FVC less than the lower limit of normal plus FEV1:FVC greater than the lower limit of normal); total lung capacity z-score −0.26 SD (95% CI −0.38 to –0.13), p<0.001; functional residual capacity −0.16 SD (−0.34 to –0.08), p=0.001; and residual volume −0.18 SD (−0.31 to –0.05), p=0.008. Reduced lung volumes were accompanied by increased carbon monoxide transfer coefficient at both time points (z-score +0.29 SD (0.11 to 0.49), p=0.001 and +0.17 SD (0.04 to 0.29), p=0.008, respectively).

Discussion 

For this community-based population, doctor-diagnosed childhood pneumonia and/or pleurisy were associated with obstructed lung function at age 7 for children who had current asthma symptoms, but with evidence of ‘smaller lungs’ when in middle age.

DOI: http://dx.doi.org/10.1136/thoraxjnl-2019-213389

 

Footnotes

EHW and SCD are joint senior authors.

EHW and SCD contributed equally.

Presented at Part of this work was presented by oral presentation at the regional Thoracic Society of Australia and New Zealand (TSANZ) and thematic poster at the American Thoracic Society Conference, San Diego, 2014.

Funding 

This study was supported by the National Health and Medical Research Council (NHMRC) of Australia (research grants 299901 and 1021275); the University of Melbourne; Clifford Craig Foundation; the Victorian, Queensland and Tasmanian Asthma Foundations; Royal Hobart Hospital; Helen MacPherson Smith Trust; GlaxoSmithKline; and John L Hopper. JLP, CL, AL, EHW and SD are funded through the NHMRC of Australia. JLP was also in part supported by Lung Foundation Australia (LFA). ABC is funded by an NHMRC Practitioner Fellowship (APP1154302) and Children’s Hospital Foundation (Queensland, grant 50286). The funding agencies had no direct role in the conduct of the study, the collection, management, statistical analysis and interpretation of the data, preparation, or approval of the manuscript.

Competing interests 

CFM has directed speaker fees to her institution from Menarini and AstraZeneca. MJA has received investigator-initiated grants for unrelated research from Pfizer and Boehringer Ingelheim, and an unrelated consultancy from Sanofi. BRT has received speaker fees from Mundipharma Australia and AstraZeneca. ABC has received other fees from GlaxoSmithKline. JLP has received a travel grant from Boehringer Ingelheim.

Patient consent for publication 

Not required.

Ethics approval 

This study was approved by separate human ethics review committees at all participating institutions, principally The University of Melbourne (040375) and the University of Tasmania (H0012710). Written informed consent was obtained from all participants.

Provenance and peer review 

Not commissioned; externally peer reviewed.

Data availability statement 

Data may be obtained from a third party and are not publicly available.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Copyright information: © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.

Keywords: Pneumonia; Pediatrics.

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#Time for The #Lancet to #realign with the #evidence on #ecigarettes? (Lancet, summary)

[Source: The Lancet, full page: (LINK). Summary, edited.]

Time for The Lancet to realign with the evidence on e-cigarettes?

John N Newton

Published: October 18, 2019 / DOI: https://doi.org/10.1016/S0140-6736(19)32486-9

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Summary

At a time of crisis, there is pressure to act, but at such a time, it is especially important that any action is informed by rational assessment of the relevant scientific evidence. The ongoing outbreak of vaping-associated respiratory illness in the USA is a case in point. A serious problem such as this requires a serious and well informed response.

(…)

I am director of Health Improvement at Public Health England.

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Copyright © 2019 Elsevier Ltd. All rights reserved.

Keywords: Electronic cigarettes; Vaping; Unexplained illness; Pneumonia.

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#Pneumonia #research: time to fill in the gaps (Lancet Resp Med., summary)

[Source: The Lancet Respiratory Medicine, full page: (LINK). Abstract, edited.]

Pneumonia research: time to fill in the gaps

The Lancet Respiratory Medicine / Published: October 17, 2019 / DOI: https://doi.org/10.1016/S2213-2600(19)30400-X

 

Summary

Pneumonia remains a leading cause of death worldwide without substantial improvements in mortality since the introduction of antibiotics over 50 years ago. Approximately 1 million adults in the USA attend hospital for the treatment of pneumonia each year, and 50 000 die from the disease, with the majority being older than 65 years. Community-acquired pneumonia (CAP) is responsible for most of the health care burden of pneumonia and on Oct 1, 2019, the American Thoracic Society released new guidelines on the diagnosis and treatment of adults with CAP.

(…)

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Copyright © 2019 Elsevier Ltd. All rights reserved.

Keywords: Pneumonia.

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#Risk of #pneumonia among #residents living near #goat and #poultry #farms during 2014-2016 (PLoS One, abstract)

[Source: PLoS One, full page: (LINK). Abstract, edited.]

OPEN ACCESS /  PEER-REVIEWED / RESEARCH ARTICLE

Risk of pneumonia among residents living near goat and poultry farms during 2014-2016

Pim M. Post , Lenny Hogerwerf, Anke Huss, Ronald Petie, Gert Jan Boender, Christos Baliatsas, Erik Lebret, Dick Heederik, Thomas J. Hagenaars, C. Joris IJzermans, Lidwien A. M. Smit

Published: October 14, 2019 / DOI: https://doi.org/10.1371/journal.pone.0223601

 

Abstract

In the Netherlands, an association was found between the prevalence of pneumonia and living near goat and poultry farms in 2007–2013. This association then led to regulatory decisions to restrict the building of new goat farms and to reduce emissions of poultry farms. Confirmation of these results, however, is required because the period of previous analyses overlapped a Q-fever epidemic in 2007–2010. To confirm the association, we performed a population-based study during 2014–2016 based on general practitioner (GP) data. Electronic medical records of 90,183 persons were used to analyze the association between pneumonia and the population living in the proximity (within 500–2000 m distance) of goat and poultry farms. Data were analyzed with three types of logistic regression (with and without GP practice as a random intercept and with stratified analyses per GP practice) and a kernel model to discern the influence of different statistical methods on the outcomes. In all regression analyses involving adults, a statistically significant association between pneumonia and residence within 500 meters of goat farms was found (odds ratio [OR] range over all analyses types: 1.33–1.60), with a decreasing OR for increasing distances. In kernel analyses (including all ages), a population-attributable risk between 6.0 and 7.8% was found for a distance of 2000 meters in 2014–2016. The associations were consistent across all years and robust for mutual adjustment for proximity to other animals and for several other sensitivity analyses. However, associations with proximity to poultry farms are not supported by the present study. As the causes of the elevated pneumonia incidence in persons living close to goat farms remain unknown, further research into potential mechanisms is required for adequate prevention.

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Citation: Post PM, Hogerwerf L, Huss A, Petie R, Boender GJ, Baliatsas C, et al. (2019) Risk of pneumonia among residents living near goat and poultry farms during 2014-2016. PLoS ONE 14(10): e0223601. https://doi.org/10.1371/journal.pone.0223601

Editor: Eric HY Lau, The University of Hong Kong, CHINA

Received: May 22, 2019; Accepted: September 24, 2019; Published: October 14, 2019

Copyright: © 2019 Post et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: In consultation with the Medical Ethical Committee of the University Medical Centre of Utrecht that approved the study protocol (number 13/533), data are not publicly available due to privacy protection of participants. Sharing an anonymized and de-identified dataset is not possible as it would still contain Electronic Health Records and address data of GP patients, which could potentially lead to the identification of subjects. The data for this study are derived from the NIVEL Primary Care Database. More information about the NIVEL Primary Care Database can be found at https://www.nivel.nl/en/nivel-primary-care-database. Requests for data can be sent to zorgregistraties@nivel.nl. Because of the granularity of the data and the requirements for data protection according to the Dutch Data Protection Act and the General Data Protection Regulation, access to the data is limited. The governance structure (data access committee) of the NIVEL Primary Care Database assesses data requests on data protection, scientific soundness of the request and public interest. Part of the governance structure is the privacy committee of the NIVEL Primary Care Database. For questions on data access, R. Coppen, member of this privacy committee and Data Protection Officer of NIVEL, may be contacted. He is registered as Data Protection Officer at the Dutch Data Protection Authority, see https://autoriteitpersoonsgegevens.nl/nl/onderwerpen/algemene-informatie-avg/functionaris-gegevensbescherming-fg

Funding: The work in this paper was commissioned to the Netherlands Institute for Health Services Research (NIVEL), in collaboration with the Institute for Risk Assessment Sciences (IRAS), Utrecht University, and Wageningen University and Research, The Netherlands. It was funded by the Ministry of Health, Welfare and Sport and the Ministry of Agriculture, Nature and Food Quality of The Netherlands [through grant number BO-43-013.01-007]. PMP analyzed the data as part of his PhD-project, which is supervised by Lenny Hogerwerf and funded by the Strategic Programme (SPR) of the National Institute for Public Health and the Environment (RIVM), The Netherlands. The funding sources had no role in the study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.

Competing interests: The authors have declared that no competing interests exist.

Keywords: Goat; Poultry; Pneumonia; Human; Netherlands.

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#Pneumococcal #serotype #trends, #surveillance and #risk factors in #UK adult #pneumonia, 2013–18 (Thorax, abstract)

[Source: Thorax, full page: (LINK). Abstract, edited.]

Pneumococcal serotype trends, surveillance and risk factors in UK adult pneumonia, 2013–18

Harry Pick1,2, Priya Daniel3, Chamira Rodrigo4, Thomas Bewick3, Deborah Ashton4, Hannah Lawrence5,6, Vadsala Baskaran1,6, Rochelle C Edwards-Pritchard2, Carmen Sheppard7, Seyi D Eletu7, Samuel Rose7, David Litt7, Norman K Fry8, Shamez Ladhani8, Meera Chand9, Caroline Trotter10, Tricia M McKeever6, Wei Shen Lim1

Author affiliations: 1 Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK; 2 Division of Respiratory Medicine, University of Nottingham, Nottingham, UK; 3 Respiratory Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK; 4 Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK; 5 Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK; 6 Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK; 7 Respiratory and Vaccine Preventable Bacteria Reference Unit, Public Health England Colindale, London, UK; 8 Immunisation and Countermeasures Division, Public Health England Colindale, London, UK; 9 Tuberculosis, Acute Respiratory, Gastrointestinal, Emerging/Zoonotic Infections, Travel and Migrant Health Service (TARGET), Public Health England Colindale, London, UK; 10 Disease Dynamic Unit, Department of Veterinary Medicine, University of Cambridge, Cambridge, UK

Correspondence to Dr Harry Pick, Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham NG5 1PB, UK; harry.pick@nhs.net

 

Abstract

Background 

Changes over the last 5 years (2013–18) in the serotypes implicated in adult pneumococcal pneumonia and the patient groups associated with vaccine-type disease are largely unknown.

Methods 

We conducted a population-based prospective cohort study of adults admitted to two large university hospitals with community-acquired pneumonia (CAP) between September 2013 and August 2018. Pneumococcal serotypes were identified using a novel 24-valent urinary monoclonal antibody assay and from blood cultures. Trends in incidence rates were compared against national invasive pneumococcal disease (IPD) data. Persons at risk of vaccine-type pneumonia (pneumococcal conjugate vaccine (PCV)13 and pneumococcal polysaccharide vaccine (PPV)23) were determined from multivariate analyses.

Findings 

Of 2934 adults hospitalised with CAP, 1075 (36.6%) had pneumococcal pneumonia. The annual incidence of pneumococcal pneumonia increased from 32.2 to 48.2 per 100 000 population (2013–18), predominantly due to increases in PCV13non7-serotype and non-vaccine type (NVT)-serotype pneumonia (annual incidence rate ratio 1.12, 95% CI 1.04 to 1.21 and 1.19, 95% CI 1.10 to 1.28, respectively). Incidence trends were broadly similar to IPD data. PCV13non7 (56.9% serotype 3) and PPV23non13 (44.1% serotype 8) serotypes were identified in 349 (32.5%) and 431 (40.1%) patients with pneumococcal pneumonia, respectively. PCV13-serotype pneumonia (dominated by serotype 3) was more likely in patients in the UK pneumococcal vaccination clinical risk group (adjusted OR (aOR) 1.73, 95% CI 1.31 to 2.28) while PPV23-serotype pneumonia was more likely in patients outside the clinical risk group (aOR 1.54, 95% CI 1.13 to 2.10).

Interpretation 

The incidence of pneumococcal CAP is increasing, predominantly due to NVT serotypes and serotype 3. PPV23-serotype pneumonia is more likely in adults outside currently identified clinical risk groups.

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DOI: http://dx.doi.org/10.1136/thoraxjnl-2019-213725

 

Footnotes

Contributors 

HJP, CS and WSL were responsible for study conception and design. HJP, PD, CR, TB, DA, HL, VB, RCE-P, CS and SE were responsible for data acquisition. HJP, TMM and CT were responsible for the statistical analysis. HJP and WSL drafted the initial versions of the Article. All authors contributed to data interpretation and read, commented on and approved the final version of the article.

Funding 

This study is independent research supported by the Nottingham National Institute for Health Research Biomedical Research Centre (NIHR BRC) and arising from an unrestricted investigator-initiated research grant from Pfizer. The study concept was developed and agreed by the authors with no input from the funding bodies; Pfizer had no part in the design or execution of the study, the analysis and interpretation of the results, the writing of this manuscript or the decision to submit for publication. The data are the sole responsibility of the authors and the sponsor for the study was Nottingham University Hospitals NHS Trust.

Disclaimer 

The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR or PHE.

Competing interests 

None declared.

Patient consent for publication 

Not required.

Ethics approval 

Study procedures were approved by the Nottingham Research Ethics Committee (REC reference 08/H0403/80).

Provenance and peer review 

Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s Rights. You will be able to get a quick price and instant permission to reuse the content in many different ways.

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Keywords: Streptococcus pneumoniae; Vaccines; UK; Pneumonia; IPD.

—–

#Nasopharyngeal #carriage of invasive #pneumococcal serotypes during #childhood #community-acquired alveolar #pneumonia is associated with specific clinical presentation (J Infect Dis., abstract)

[Source: Journal of Infectious Diseases, full page: (LINK). Abstract, edited.]

Nasopharyngeal carriage of invasive pneumococcal serotypes during childhood community-acquired alveolar pneumonia is associated with specific clinical presentation

Yaniv Faingelernt, Ron Dagan, Noga Givon-Lavi, Shalom Ben-Shimol, Jacob Bar-Ziv, David Greenberg

The Journal of Infectious Diseases, jiz513, https://doi.org/10.1093/infdis/jiz513

Published: 05 October 2019

 

Abstract

Background

Streptococcus pneumoniae (Pnc) serotypes differ in invasive potential. We examined whether community-acquired alveolar pneumonia (CAAP) in children carrying common recognized invasive pneumococcal serotypes (1, 5, 7F, 14 and 19A; PnIST) differs from CAAP in children carrying less invasive serotypes (non-PnIST) or no Pnc (Pnc-neg).

Methods

Children <5 years visiting the only regional Pediatric Emergency Room, with radiologically-proven CAAP were enrolled. Nasopharyngeal cultures were processed for pneumococcal isolation and serotyping. Clinical/demographic characteristics were recorded. The study was conducted before pneumococcal conjugate vaccine implementation in Israel.

Results

A total of 1,423 CAAP episodes were recorded: PnIST, 300 (21.1%); non-PnIST, 591 (41.5%); and Pnc-neg, 532 (37.4%). After adjustment for age, ethnicity, seasonality and previous antibiotics, the following variables were positively associated with PnISRT carriage compared to both groups: temperature ≥39°C, peripheral WBC ≥20,000/mm3, C-reactive protein ≥70.0 mg/L and serum sodium <135 mEq/L. Lower oxygen saturation, viral detection and comorbidities were negatively associated with Pn-IST carriage (odds ratios <1.0). Differences between non-PnIST carriers and Pnc-neg groups were smaller or non-significant.

Conclusions

Young children with CAAP carrying common PnIST had a lower proportion of comorbidities, hypoxemia and viral detection, and had more intense systemic inflammatory response than those carrying non-PnISR or not carrying Pnc.

community-acquired alveolar pneumonia, children, pneumococcal serotypes, clinical signs, laboratory characteristics

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Keywords: Streptococcus pneumoniae; Invasive pneumococcal disease; Pediatrics.

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