Journal of infection and public health · 2025
Clinical features and antibiotic resistance in pediatric pneumococcal meningitis in Southern Vietnam, 2012-2023: A multicenter retrospective study.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Truong Hieu Cong, Phan Thanh Van, Nguyen Hung Thanh, Ho Thang Vinh, Vo Dai Thi Trang, Nguyen Thuong Vu, Nguyen Trung Vu, Speybroeck Niko
Аннотация
BACKGROUND: Streptococcus pneumoniae is a major cause of morbidity and mortality in children. This study investigates the clinical features, cerebrospinal fluid (CSF) findings, serotype distribution, and antibiotic resistance patterns in Vietnamese children aged 1-59 months with pneumococcal meningitis (PM).
METHODS: This retrospective study (2012-2023) was conducted at two tertiary pediatric hospitals in Ho Chi Minh City. CSF samples from probable bacterial meningitis (PBM) cases were analyzed using biochemistry, culture, and real-time polymerase chain reaction (rt-PCR). Serotyping and antibiotic-resistance genes were identified using quadriplex rt-PCR.
RESULTS: Among 2922 PBM cases, 155 (5.3 %) were confirmed as PM. Of these, 58.7 % occurred in children under one year and 62.6 % during the rainy season. Fever (98.1 %) and vomiting (67.7 %) were the most common symptoms. Infants under 12 months frequently exhibited nonspecific signs like convulsions (48.4 %) and bulging fontanels (34.1 %), while older children displayed classic symptoms such as neck stiffness (32.4 %) and behavioral changes (26.5 %). CSF analysis revealed turbid appearance, WBC ≥ 100 cells/mm³ (85.2 %), and protein ≥ 1 g/L (60.0 %) (p < 0.05). Severe outcomes were noted in 17.4 % of PM cases, with a 3.2 % fatality rate. The 13-valent pneumococcal conjugate vaccine (PCV13) serotypes caused 81.3 % of confirmed cases, predominantly serotypes 6 A/B (34.8 %) and 19 F (20.0 %). Among 137 isolates tested, high prevalence rates were observed for the pbp2b (68.6 %), mef(A)/erm(B) (93.4 %), and tetM (92.0 %) resistance genes. Additionally, 61.3 % of isolates showed multiple resistance genes, particularly in serotypes 6 A/B, 23 F, 9 V, and 13. Antibiotic resistance in non-PCV13 serotypes increased over time.
CONCLUSIONS: PM in Vietnamese children presents age-specific clinical presentations and is predominantly caused by highly resistant PCV13 serotypes. The rising resistance in non-PCV13 serotypes poses a formidable challenge in managing pneumococcal infections. These findings emphasize the urgent need for PCV introduction in the national immunization program and ongoing resistance surveillance.
METHODS: This retrospective study (2012-2023) was conducted at two tertiary pediatric hospitals in Ho Chi Minh City. CSF samples from probable bacterial meningitis (PBM) cases were analyzed using biochemistry, culture, and real-time polymerase chain reaction (rt-PCR). Serotyping and antibiotic-resistance genes were identified using quadriplex rt-PCR.
RESULTS: Among 2922 PBM cases, 155 (5.3 %) were confirmed as PM. Of these, 58.7 % occurred in children under one year and 62.6 % during the rainy season. Fever (98.1 %) and vomiting (67.7 %) were the most common symptoms. Infants under 12 months frequently exhibited nonspecific signs like convulsions (48.4 %) and bulging fontanels (34.1 %), while older children displayed classic symptoms such as neck stiffness (32.4 %) and behavioral changes (26.5 %). CSF analysis revealed turbid appearance, WBC ≥ 100 cells/mm³ (85.2 %), and protein ≥ 1 g/L (60.0 %) (p < 0.05). Severe outcomes were noted in 17.4 % of PM cases, with a 3.2 % fatality rate. The 13-valent pneumococcal conjugate vaccine (PCV13) serotypes caused 81.3 % of confirmed cases, predominantly serotypes 6 A/B (34.8 %) and 19 F (20.0 %). Among 137 isolates tested, high prevalence rates were observed for the pbp2b (68.6 %), mef(A)/erm(B) (93.4 %), and tetM (92.0 %) resistance genes. Additionally, 61.3 % of isolates showed multiple resistance genes, particularly in serotypes 6 A/B, 23 F, 9 V, and 13. Antibiotic resistance in non-PCV13 serotypes increased over time.
CONCLUSIONS: PM in Vietnamese children presents age-specific clinical presentations and is predominantly caused by highly resistant PCV13 serotypes. The rising resistance in non-PCV13 serotypes poses a formidable challenge in managing pneumococcal infections. These findings emphasize the urgent need for PCV introduction in the national immunization program and ongoing resistance surveillance.