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BACKGROUND: The incidence of invasive pneumococcal disease (IPD) varies depending on a number of factors, including vaccine uptake, in both children and adults, the geographic location, and local serotype prevalence. There are limited data about the burden of Streptococcus pneumoniae (Spn), serotype distribution, and clinical characteristics of adults hospitalized due to IPD in Colombia. The objectives of this study included assessment of Spn serotype distribution, clinical characteristics, mortality, ICU admission, and the need for mechanical ventilation. METHODS: This was an observational, retrospective, a citywide study conducted between 2012 and 2019 in Bogotá, Colombia. We analyzed reported positive cases of IPD from 55 hospitals in a governmental pneumococcal surveillance program. Pneumococcal strains were isolated in each hospital and typified in a centralized laboratory. This is a descriptive study stratified by age and subtypes of IPD obtained through the analysis of medical records. RESULTS: A total of 310 patients with IPD were included, of whom 45.5% were female. The leading cause of IPD was pneumonia (60%, 186/310), followed by meningitis. The most frequent serotypes isolated were 19A (13.87%, 43/310) and 3 (11.94%, 37/310). The overall hospital mortality rate was 30.3% (94/310). Moreover, 52.6% (163/310 patients) were admitted to the ICU, 45.5% (141/310) required invasive mechanical ventilation and 5.1% (16/310) non-invasive mechanical ventilation. CONCLUSION: Pneumococcal pneumonia is the most prevalent cause of IPD, with serotypes 19A and 3 being the leading cause of IPD in Colombian adults. Mortality due to IPD in adults continues to be very high.

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AIMS: The purpose of this novel study was to evaluate the food environment at a Brazilian university, encompassing 6 restaurants and 13 snack bars. The investigation uniquely analyses the food environment (barriers, facilitators, type of foods and prices). This was a food-based analysis of the nutritional quality of the products sold on campus. METHODS: A cross-sectional descriptive design was used, applying the classic Nutrition Environment Measures Survey-Restaurants (NEMS-R) adapted for Brazil and an original methodology to evaluate and classify qualitatively the nutritional quality and characteristics of the food. A census of all campus food environments was applied. RESULTS: The main results show most food and beverage products were made with processed ingredients and had a lower nutritional quality and price when compared with similar products made on premises, that is, processed iced tea compared with fresh tea ( p < .001), fried refined flour salgados compared with baked wholegrain flour salgados ( p < .001) and refined flour biscuits compared with those made with whole grains ( p = .028). Only 16% of the outlets provided food ingredients or nutritional information of products available. CONCLUSION: The overall options for healthy food choices and good nutritional quality on campus were mostly limited by the availability and higher prices of products. These findings could be used to develop new policy perspectives for the offering of healthy food items and to facilitate better food choices among students in a healthier food environment.

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Las fluoroquinolonas respiratorias, son efectivas contra la mayoría de los posibles patógenos de neumonía adquirida en la comunidad (NAC), tienen biodisponibilidad adecuada y baja toxicidad. Podrían ser consideradas una opción de primera línea para la NAC. Ciprofloxacina muestra tasas bajas de resistencia a S. pneumoniae, pero un aumento creciente de resistencia para enterobacterias. Existe aumento de la resistencia a quinolonas del neumococo en varios países, en Hong Kong llegó al 13.3 %. En Argentina la resistencia a levofloxacina fue 2% en 2004. Preocupa la coexistencia de resistencia de S. pneumoniae a penicilina y macrólidos. En pacientes que necesitan internación por su gravedad, se puede usar fluoroquinolonas como tratamiento alternativo. Las quinolonas son activas ®in vitro¼ contra Myobacterium tuberculosis, el uso de estos antibióticos con sospecha de NAC que en realidad padecen tuberculosis se asocia a retraso en el diagnóstico y creciente resistencia a fluoroquinolonas. No hay evidencias las quinolonas como primera opción en el paciente ambulatorio con NAC, produzca mejores resultados que losBeta-lactámicos. Esa indicación ocasionaría un aumento importante en el consumo de esas drogas, lo que traería como consecuencia, un aumento de la resistencia del neumococo y otros gérmenes sin una clara ventaja terapéutica.

The newer fluoroquinolones are active against most of the potencial pathogens of community acquired pneumonia (CAP), and have high bioavailability and low toxicity. They could be considered a first line option for CAP. Ciprofloxacin presents low resistance rates for S.pneumoniae, but an increasing incidence of resistance among enterobacteriaceae.Quinolones’ resistance is growing, in Hong Kong achieved 13.3%. In Argentina resistance to levofloxacin was 2% in 2004. The coexistence of S. pneumoniae resistant to penicillinand macrolides is worrisome. Fluoroquinolones could be an alternative for those CAP patients that need to be admitted because of their severity of illness. Quinolones are active ®invitro¼ against Myobacterium tuberculosis, the use of these antibiotics for CAP suspicion in patients with tuberculosis has been associated with a delay in the therapy and worseningof resistance to fluoroquinolones. There are not evidences supporting that the use of these antibiotics as the first line of therapy in the outpatient with CAP produces better results than beta-lactams. The indiscriminate use may produce a significant increase in the use of quinolones and as a consequence to an increase of resistance of pneumococcus and other microorganisms, without a clear advantage.

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