Antecedentes: La neumonía neumocócica sigue siendo un problema de salud pública. En Perú, la vacuna antineumocócica conjugada 7-valente (PCV7) fue introducida en 2009, la 10-valente (PCV10) en 2011 y la 13-valente (PCV13) en 2015. Objetivo: Determinar las características clínicas y microbiológicas de pacientes pediátricos hospitalizados por neumonía neumocócica durante el período pre y post introducción de PCVs en Lima, Perú. Materiales y métodos: Se realizó un análisis secundario de tres estudios de vigilancia pasiva de Enfermedad Neumocócica Invasiva (ENI) realizados en hospitales públicos y clínicas privadas en Lima entre los periodos 2006-2008 [pre-PCV7(ENI-1)], 2009-2011 [post- PCV7(ENI-2)] y 2016-2019 [post-PCV13(ENI-3)]. Se comparó los periodos previos a la PCV7 y posterior a la introducción de las tres PCVs en el Perú. Se incluyeron pacientes pediátricos con diagnóstico clínico de neumonía y cultivo positivo a Streptococcus pneumoniae en sangre o líquido pleural. Resultados: Se identificaron 128 casos de neumonía neumocócica: ENI-1(48 casos), ENI-2(30 casos) y ENI-3(50 casos). En ENI-1 y ENI-2 hubo más casos en lactantes (77,1% y 43,3%), en ENI-3 más en pre-escolares (62%). El 71,9% fueron aisladas de hemocultivos y 28,1% de líquido pleural. Se encontró un aumento de neumonías complicadas: de 14,6% a 72%. El 56% de neumonías complicadas fueron empiemas. Hubo un incremento en la frecuencia del serotipo 19A: 6,3% a 68%. La resistencia a penicilina y ceftriaxona se mantuvo baja (6% y 2%), mientras a azitromicina aumentó de 27% a 92%. Conclusiones: Posterior a la introducción de las PCVs se observa un incremento en la frecuencia de neumonías neumocócicas complicadas y del 19A. La penicilina mantiene bajos niveles de resistencia y continúa siendo el antibiótico de elección para neumonía neumocócica en Lima.
Background: Pneumococcal pneumonia remains a public health problem. In Peru, the 7-valent pneumococcal conjugate vaccine (PCV7) was introduced in 2009, the 10-valent (PCV10) in 2011, and the 13-valent (PCV13) in 2015. Objective: Determine the clinical and microbiological characteristics of pediatric patients hospitalized due pneumococcal pneumonia during the pre and post-introduction of PCVs in Lima, Peru. Material and Methods: A secondary analysis was conducted using data from three passive surveillance studies of Invasive Pneumococcal Disease (IPD) conducted in public hospitals and private clinics in Lima during the periods 2006-2008[pre-PCV(IPD-1)], 2009-2011[post-PCV7(IPD-2)] and 2016- 2019[post-PCV13(IPD-3)]. The periods before and after the introduction of the three PCVs in Peru were compared. Pediatric patients with clinical diagnosis of pneumonia and positive culture for Streptococcus pneumonieae in blood or pleural fluid were included. Results: A total of 128 cases of pneumococcal pneumonia were identified: IPD-1(48 cases), IPD-2(30 cases) and IPD-3(50 cases). In IPD-1 and IPD-2, there were more cases in infants (77.1% and 43.3%), while in IPD-3, mores cases were seen in preschool-aged children (62%). 71.9% were isolated from blood cultures and 28.1% from pleural fluid. There was an increase in complicated pneumonia from 14.6% to 72%. 56% of complicated pneumonia were empyema. There was an increase in the frequency of serotype 19A from 6.3% to 68%. Resistance to penicillin and ceftriaxone remained low (6% and 2%), while resistance to azithromycin increased from 27% to 92% among others. Conclusions: Following the introduction of PCVs, an increase in the frequency of complicated pneumococcal pneumonia and 19A serotype was observed. Penicillin maintains low levels of resistance and continues to be the antibiotic of choice for pneumococcal pneumonia in Lima.
