title: [Pneumococcal pneumonia in the era of heptavalent pneumococcal conjugate vaccine].
abstract: BACKGROUND
  To describe clinical features, complications, serotypes and antibiotic resistance in pneumococcal pneumonia in our environment after the generalization of the heptavalent conjugate vaccine (PCV-7) in paediatrics.
  
  
  METHODS
  Prospective study of episodes of pneumococcal pneumonia, with positive cultures in patients treated in the emergency department from January 2006 to February 2010.
  
  
  RESULTS
  We studied 346 episodes in 320 patients, 335 belonged to 309 adult patients, 221 (71.5%) males, median age 68 years (range 16-94), and 11 episodes to patients<15 years. Two-hundred and thirty seven (68.5%) episodes were community acquired. Bacteraemia was present in 130 (37.6%) cases, with a tendency towards an increased risk in patients < 65 years (OR=1.56, 95% CI 0.96- 2.56, P=.07). Thirteen (3.8%) patients developed empyema and 33 (9.5%) septic shock. The mean age of patients with empyema was lower (P=.03). In the multivariate analysis were related to the presence of bacteraemia: a history of chronic respiratory disease (OR=0.45, 95% CI 0.25-0.81, P=.008), positive urinary antigen (OR 2.02, 95% CI 1 13-3.62, P=.01) and pleural effusion (OR=3.86, 95% CI 1.79-8.35, P=.001). Shock was associated with Fine IV-V stage (OR=23.6, 95% CI 4.96-112.82, P<.001), age < 65 years (OR=4.47, 95% CI 1.75-11.39, P=.002) and pleural effusion (OR=4.15, 95% CI 1.65 to 10.41, P=.002). Increased mortality risk was associated with presence of any complication (OR=6.6, 95% CI 1.5-27.2, P=.009) and specifically septic shock (OR=3.3, 95% CI 1.06-10.3, P=.04). Most serotypes obtained were not included in the VNC-7.
  
  
  CONCLUSIONS
  Pneumococcal pneumonia after generalisation of PCV-7 is mainly related to non-vaccine serotypes. Younger patients without respiratory disease are at increased risk of bacteraemia, empyema, and septic shock, the latter being associated with a higher mortality.
authors.affiliation: Servicio de Medicina Interna, Hospital Son Llàtzer, Red Española de Investigación en Patología Infecciosa (REIPI), Palma de Mallorca, Islas Baleares, España. apayeras@hsll.es
authors.forename: Antoni
authors.initials: A
authors.lastname: Payeras
authors.forename: Aroa
authors.initials: A
authors.lastname: Villoslada
authors.forename: Margarita
authors.initials: M
authors.lastname: Garau
authors.forename: María
authors.initials: M
authors.lastname: Borras
authors.forename: Antonio
authors.initials: A
authors.lastname: Pareja
authors.forename: David
authors.initials: D
authors.lastname: Beingolea
authors.forename: Mercedes
authors.initials: M
authors.lastname: García-Gasalla
authors.forename: M del Carmen
authors.initials: Mdel C
authors.lastname: Gallegos
authors.forename: Carlos José
authors.initials: CJ
authors.lastname: Alonso-Villaverde
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D017714:Community-Acquired Infections / Q000453:epidemiology; D015897:Comorbidity; D003428:Cross Infection / Q000453:epidemiology; D024901:Drug Resistance, Multiple, Bacterial; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D016724:Empyema, Pleural / Q000453:epidemiology / Q000209:etiology; D005260:Female; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D006801:Humans; D007121:Immunocompetence; D008297:Male; D008875:Middle Aged; D022242:Pneumococcal Vaccines; D011018:Pneumonia, Pneumococcal / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality / Q000517:prevention & control; D011446:Prospective Studies; D012306:Risk; D012703:Serotyping; D012772:Shock, Septic / Q000209:etiology / Q000401:mortality; D013030:Spain / Q000453:epidemiology; D013296:Streptococcus pneumoniae / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification; D014611:Vaccination / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D022242:Pneumococcal Vaccines