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Recurrent pneumococcal invasive disease in the Region of Madrid during a five-year period

  • Clinical and Epidemiological Study
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Abstract

Purpose

The aim of this study was to describe the clinical and microbiological characteristics of recurrent invasive pneumococcal disease (RIPD) cases identified in the Region of Madrid between January 2007 and December 2011.

Methods

Streptococcus pneumoniae serotyping was performed by Pneumotest-Latex and Quellung reaction. Molecular typing was carried out by pulsed-field gel electrophoresis (PFGE). A relapse was defined as any case of RIPD caused by strains with similar PFGE profile. Re-infections were defined by detection of recurrent episodes caused by strains with different PFGE patterns.

Results

During the study period, 2,929 S. pneumoniae strains isolated from 2,858 patients with invasive pneumococcal disease (IPD) were studied. In 61 patients (2.1 %), 132 episodes of RIPD were detected (two episodes in 52 patients, three in 8 and four in 1). Twelve patients had relapses, 47 had re-infections and two had re-infections followed by relapses. Common risk factors to developing RIPD were HIV (42.6 %) and haematological malignancies (16.4 %). The most frequent serotypes were 8 (16 episodes) and 19A (15 episodes). Fourteen strains that were resistant to levofloxacin were also resistant to erythromycin. The proportion of strains co-resistant to erythromycin and levofloxacin was significantly higher in relapses (11/29) than in re-infections (3/103).

Conclusions

The occurrence of repeated episodes of IPD in the same patient over the time is not an exceptional issue. Some underlying conditions that may favour these recurrences, mainly immunosuppression, need to be considered in patients having an episode of IPD.

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Conflict of interest

Juan Carlos Sanz has received assistance from Pfizer for attending to scientific meetings. The others authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Unidad de Microbiología Clínica, Laboratorio Regional de Salud Pública, Comunidad de Madrid, C/Sierra de Alquife 8, 28053, Madrid, Spain

    J. C. Sanz & B. Ramos

  2. Servicio de Microbiología, Hospital Clínico San Carlos, Madrid, Spain

    I. Rodríguez-Avial & E. Ríos

  3. Servicio de Microbiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain

    E. Cercenado

Authors
  1. J. C. Sanz
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  2. I. Rodríguez-Avial
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  3. E. Ríos
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  4. B. Ramos
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  5. E. Cercenado
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Corresponding author

Correspondence to J. C. Sanz.

Additional information

On behalf of the Madrid Streptococcus pneumoniae Microbiological Study Group.

A list of members of the Madrid Streptococcus pneumoniae Microbiological Study Group is given in Appendix.

Appendix

Appendix

Contributing members of the Madrid Streptococcus pneumoniae Microbiological Study Group are: Mercedes Marín (Hospital General Universitario Gregorio Marañón); Francisca Sanz, Fernando Chaves, Maria Angeles Orellana (Hospital Universitario 12 de Octubre); Elia Gómez, Elena Loza, María Antonia Meseguer (Hospital Universitario Ramón y Cajal); Fernando González-Romo, Esther Culebras (Hospital Clínico San Carlos); Juana Cacho (Hospital Universitario de Getafe); Beatriz Orden, Isabel Sanchez (Hospital Universitario Puerta de Hierro Majadahonda); María del Carmen de las Cuevas, Ana Correa, Diego Domingo, Buenaventura Buendía (Hospital Universitario de La Princesa); Isabel Wilhelmi (Hospital Universitario Severo Ochoa); Maria Pilar Romero, Adela García-Perea (Hospital Universitario La Paz); Alberto Delgado, José Valverde (Hospital Universitario Fundación Alcorcón); Peña Gómez-Herrúz (Hospital Universitario Príncipe de Asturias); Ricardo Fernández Roblas, María Carolina Isea Peña (Fundación Jiménez Díaz); Belén Hernández-Milán (Hospital Infantil Universitario Niño Jesús); Jose Luis Gómez Garcés (Hospital Universitario de Móstoles); Santiago Salso (Hospital Universitario Madrid Montepríncipe); Elena García-Peñuela (Hospital Sanitas La Zarzuela); Dolores Martín (Hospital Infanta Cristina); Paula Fernández, Diana Monclús (Hospital San Rafael); Maria Jose Uría (Hospital del Sureste); Andrea González Prieto (Hospital del Tajo); Almudena Alhambra, (Hospital Universitario Madrid y Madrid Torrelodones), Carmen Gómez (Madrid Sanchinarro); Aída Sanchez-García, Elena Sáez (Hospital Infanta Sofía); Luis Ruiz Velasco (Hospital Moncloa); Luisa García-Picazo (Hospital El Escorial); Carolina Camplelo (Hospital Infanta Leonor); Laura Molina, Isabel García-Arata (Hospital de Fuenlabrada); Mercedes Martínez-Arroyo (Hospital Sanitas La Moraleja); Esteban Aznar (Hospital del Henares); Mari-Fran Ramos (Hospital Central de la Defensa Gómez Ulla); Ana Enríquez (Hospital Carlos III); Amparo Catón (Sanatorio Nuestra Señora del Rosario); Isabel Jiménez (Clínica Fuensanta); Laura Navas, Pilar Sanchez de la Blanca (Hospital Los Madroños), Firdaus El Knaichi (Hospital de Torrejón). We thank Marisa Fernández, Nieves Herranz and Mariluz Alvarez for their excellent technical assistance.

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Sanz, J.C., Rodríguez-Avial, I., Ríos, E. et al. Recurrent pneumococcal invasive disease in the Region of Madrid during a five-year period. Infection 42, 475–483 (2014). https://doi.org/10.1007/s15010-013-0571-3

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