676. Multicenter Surveillance of Streptococcus pneumoniae isolates from middle ear cultures in the 13-valent Pneumococcal Conjugate Vaccine Era
Session: Oral Abstract Session: Pneumococcal Vaccine for All Ages
Friday, October 4, 2013: 10:30 AM
Room: The Moscone Center: 200-212
Background: Streptococcus pneumoniae is one of the most common organisms isolated from children with otitis media (OM).  Limited information is available on the pneumococcal serotypes associated with OM since implementation of the 13-valent pneumococcal conjugate vaccine (PCV13).

Methods: Investigators from 8 US children’s hospitals prospectively collected pneumococcal isolates from middle ear (spontaneous drainage, PE tube placement, myringotomy) or mastoid (surgical) cultures from patients whose demographic and clinical information, including prior PCV13 administration, was collected using a standard case report form.  Serotype (ST) was determined by a central laboratory and antibiotic susceptibilities were determined by the clinical microbiology at the respective children’s hospital.

Results: From 1/1/11 to 12/31/12, 267 pneumococcal isolates were recovered from middle ear (241) or mastoid (26) cultures.  The ages of the patients were: ≤ 24 mo (n=167); 25-60 mo (n=74); > 60 mo (n=26).  31 children had an underlying condition.  The most common STs were: 19A (80), 35B (23), 3 (16), 6C (15), 21 (14), 11 (13), 15B (12), 23A (11), 23B (9), 15C (8), 15A (7), and 19F (7).  Sixteen other STs were represented by 1-6 isolates each.  19F was the only PCV7 ST.  19A, 3 and 7F (1) were the only additional PCV13 STs.  ST 19A accounted for 12/26 mastoiditis isolates.  

Overall 67, 17, 66 and 46 children received 1, 2, 3 or 4 doses of PCV13, respectively. The distribution of STs 3, 19A and 19F based on age at infection and number of PCV13 doses received is shown.

 

Serotype

Number of PCV13 Doses

Age at Isolation

 

0-1

2

3

4

<2 y

3

2

1

2

0

19A

15

8

25

12

19F

1

0

0

2

2-5 y

3

5

0

0

1

19A

12

0

2

2

19F

3*

0

0

0

>5 y

3

5

0

0

0

19A

4

0

0

0

19F

1

0

0

0

*each received only 4 doses of PCV7

Penicillin susceptibilities were available for 252 isolates.  Fifty of 77 (65%) ST 19A isolates compared with 5/175 (2.9%) non-19A isolates had penicillin MICs ≥ 4.0 µg/mL (p<0.0001). 

Conclusion: For the 2 y period starting about 6 mo. after wide use of PCV13,  60% of  pneumococcal isolates recovered from children with middle ear infections at 8 US children’s hospitals were non-PCV13 STs.  STs 19A, 3 and 19F were the most common PCV13 STs noted.  ST 35B was the most common non-PCV13 ST.  Data prior to PCV13 are not available and it is too early to determine any trends.   Continued surveillance of pneumococcal isolates associated with OM is warranted.

Sheldon L. Kaplan, MD, FIDSA1, William J. Barson, MD2, Philana L. Lin, MD, MSc3, Jose R. Romero, MD4, John S. Bradley, MD, FIDSA5, Tina Q. Tan, MD6, Timothy R. Peters, MD7, Jill A. Hoffman, MD8, Kristina G. Hulten, PhD1, Kimberly J. Center, MD9 and Edward O. Mason, PhD1, (1)Baylor College of Medicine and Texas Children's Hospital, Houston, TX, (2)Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH, (3)Children's Hospital of Pittsburgh, Pittsburgh, PA, (4)University of Arkansas for Medical Sciences, Little Rock, AR, (5)Infectious Diseases, Rady Children's Hospital San Diego, San Diego, CA, (6)Northwestern University Feinberg School of Medicine, Chicago, IL, (7)Pediatrics, Wake Forest School of Medicine, Winston Salem, NC, (8)Children's Hospital, Los Angeles, Los Angeles, CA, (9)Pfizer Vaccine Research, Collegeville, PA

Disclosures:

S. L. Kaplan, Pfizer: Research Contractor, Contract for study

W. J. Barson, None

P. L. Lin, None

J. R. Romero, None

J. S. Bradley, None

T. Q. Tan, None

T. R. Peters, None

J. A. Hoffman, None

K. G. Hulten, None

K. J. Center, Pfizer: Employee and Shareholder, Salary

E. O. Mason, None

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