Nosocomial invasive pneumococcal disease in Toronto, Canada, 1995–2005

Abstract number: 1732_206

Green K., Low D., McGeer A.

Background: Recently, several outbreaks of antibiotic resistant nosocomial invasive pneumococcal disease (IPD) have been reported. We review the occurrence of nosocomial IPD in Toronto, Canada from 1995 to 2006.

Methods: Population based surveillance for IPD in residents of metropolitan Toronto and Peel region, Ontario, Canada (population 3.9M) has been on-going since 1995, and surveillance for disease associated with respiratory isolates of S. pneumoniae (SPN) since 2002. Nosocomial disease is defined using US NNISS criteria.

Results: From 1995 to 2005, 4,836 episodes of IPD have been identified of which 208 were nosocomially acquired. The overall average incidence of nosocomial IPD was 0.53/100,000/y. There was no change in incidence over time although the incidence of community-acquired IPD decreased from 13.5 to 7.9/100,000/y during the same period. The median age of patients was 68 yr (range 0.12–97 yr); 34 (16%) were children. 125 (60%) were male, 179 (86%) had chronic illness qualifying them for receipt of pneumococcal vaccine [most commonly: cancer (80, 38%), cardiac disease (73, 35%), lung disease (50, 24%), diabetes mellitus (48, 23%)]. The most common serotypes causing disease were 6B (21), 23F (20), 6A (16) and 22F (14). Overall resistance was: erythromycin 13.6%, penicillin 5.7%, ceftriaxone 2.5%, levofloxacin 3.7%, moxifloxacin 0%. From 2002 to 2006, 391 patients with respiratory isolates of SPN were identified; 103 episodes met criteria for non-bacteraemic pneumococcal pneumonia (NBPP). Median age of patients was 65 yr, 73% were male, 83% had a qualifying chronic underlying illness. The most common serotypes were 19F (67), 6A (31), 6B (25), and 3 (24). Resistance rates were: erythromycin 21%, penicillin 6.3%, ceftriaxone 4.2%, levofloxacin 1.8%, moxifloxacin 1.1%. The case fatality rate was 29% in NBPP, and 45% in IPD. In IPD episodes, levofloxacin resistance (LEVR) increased from 0 in 1995/8 to 9.5% in 2001 (P = 0.25). From 2002 to 2005, LEVR decreased in both IPD and non-invasive isolates, from 8.8% (2001) to 1.4% (2006) (P = 0.01). Examination of cases for clustering in time and space revealed clusters of 2–5 cases each comprising 38/599 (6.3%) cases.

Conclusion: Nosocomial pneumococcal disease is uncommon, but associated with a high case fatality rate. Most disease is sporadic. In Toronto, levofloxacin resistance is decreasing in nosocomial isolates while remaining stable in the community: this may be due to changes in hospital antibiotic use.

Session Details

Date: 31/03/2007
Time: 00:00-00:00
Session name: European Society of Clinical Microbiology and Infectious Diseases
Location: ICC, Munich, Germany
Presentation type:
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