Invasive pneumococcal disease at the largest pediatric hospital in Quito – Ecuador, from 2014 to 2018

Introduction: Streptococcus pneumoniae (pneumococcus) is still an important cause of pneumonia, sepsis, and meningitis in children worldwide. In Ecuador, there is a paucity of information about the invasive pneumococcal disease. Methods: This was a retrospective-cohort study that was carried out in the largest pediatric public third-level hospital in Quito, Ecuador. The study was conducted from 2014 to 2018. Medical records of patients with invasive pneumococcal disease (IPD) were analyzed. S. pneumoniae serotypes were identified, their antimicrobial susceptibility was assessed, clinical manifestations were determined, and mortality of IPD at a third-level hospital in Quito was stablished, from 2014 to 2018. Results: Most patients with IPD were under 2 years old. Pneumonia was the most frequent clinical presentation and serotype 19A was the most prevalent. S. pneumoniae isolates were resistant in different percentages to clindamycin, erythromycin, trimethoprim sulfametoxazol, penicillin, levofloxacin, ceftriaxone. Meningeal isolates showed a higher frequency of antimicrobial resistance. Although most patients had received a pneumococcal conjugated vaccine against 10 serotypes (PCV10), they still presented IPD. Discussion: Despite most patients (88.2%) had received a pneumococcal conjugate vaccine against 10 serotypes (PCV10), they still had IPD. S. pneumoniae serotype 19A was the most common cause of IPD and showed the highest prevalence of antibiotic resistance in infected children included in this study. Conclusions: Pneumonia and sepsis were the most common IPD, and serotype 19A was most frequent. National Pneumococcal surveillance by serotype in Ecuador is essential to understand the impact of PCVs in the epidemiology of invasive pneumococcal disease and to assess the effectiveness of immunization programs.