Jong Hun Kim1, Seung Hee Baik2, Byung Chul Chun3, Joon Young Song4, In-Gyu Bae5, Hyo Youl Kim6, Dong-Min Kim7, Young Hwa Choi8, Won Suk Choi9, Yu Mi Jo10, Hyun Hee Kwon11, Hye Won Jeong12, Yeon-Sook Kim13, Jeong Yeon Kim14, Jacob Lee15, Sae Yoon Kee16, Jian Hur17, Jin Won Chung18, Ki-Eun Hwang19, Min Ja Kim20. 1. Division of Infectious Diseases, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea. 2. Department of Internal Medicine, Cheju Halla General Hospital, Jeju-si, Republic of Korea. 3. Department of Preventive Medicine, Korea University College of Medicine, Seoul, Republic of Korea. 4. Division of Infectious Diseases, Department of Internal Medicine, Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea. 5. Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea. 6. Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea. 7. Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea. 8. Department of Internal Medicine, Ajou University Hospital, Suwon, Republic of Korea. 9. Division of Infectious Diseases, Department of Internal Medicine, Ansan Hospital, College of Medicine, Korea University, Ansan, Gyeonggi-do, Republic of Korea. 10. Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Republic of Korea. 11. Department of Internal Medicine, Daegu Catholic University, Daegu, Republic of Korea. 12. Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, Chungcheongbuk-do, Republic of Korea. 13. Division of Infectious Diseases, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea. 14. Division of Infectious Diseases, Department of Internal Medicine, Sahmyook Medical Center, Seoul, Republic of Korea. 15. Division of Infectious Diseases, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea. 16. Division of Infectious Diseases, Department of Internal Medicine, Konkuk University Chungju Hospital, Chungju, Republic of Korea. 17. Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Republic of Korea. 18. Division of Infectious Diseases, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea. 19. Department of Internal Medicine, School of Medicine, Wonkwang University, Iksan, Republic of Korea. 20. Division of Infectious Diseases, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea; The Research Institute of Emerging Infectious Diseases, Korea University, Seoul, Republic of Korea. Electronic address: macropha@korea.ac.kr.
Abstract
OBJECTIVES: This study aimed to characterize the risk factors for mortality in adult patients with invasive pneumococcal disease (IPD) stratified by age groups, after implementation of the national immunization program of 23-valent polysaccharide vaccine (PPSV23) for those aged ≥65 years in the Republic of Korea (ROK). METHODS: Clinical data and pneumococcal isolates from adult patients with IPD (≥18 years of age) were collected prospectively from 20 hospitals through the nationwide surveillance program from March 2013 to October 2015. RESULTS: A total of 319 patients with IPD were enrolled. Median age was 69 years. Overall in-hospital mortality was 34.2%: 17.1% in those aged 18-49 years, 23.7% in those aged 50-64 years, 33.0% in those aged 65-74 years, and 51.0% in those aged ≥75 years (p<0.001). In particular, early death within 7days of hospitalization accounted for 60.6% (66/109). While old age (≥65 years), higher Pitt bacteremia score (≥4), and bacteremic pneumonia were independently associated with IPD mortality in all age groups, an additional mortality risk factor of immunocompromised status was identified for patients aged 50-64 years. PPSV23 serotypes accounted for 64.4% (122/189) of the pneumococcal isolates serotyped. CONCLUSIONS: This study suggests that vaccine-type IPD continues to place a substantial burden on older adults in the ROK, necessitating an effective vaccination strategy for those at higher risk.
OBJECTIVES: This study aimed to characterize the risk factors for mortality in adult patients with invasive pneumococcal disease (IPD) stratified by age groups, after implementation of the national immunization program of 23-valent polysaccharide vaccine (PPSV23) for those aged ≥65 years in the Republic of Korea (ROK). METHODS: Clinical data and pneumococcal isolates from adult patients with IPD (≥18 years of age) were collected prospectively from 20 hospitals through the nationwide surveillance program from March 2013 to October 2015. RESULTS: A total of 319 patients with IPD were enrolled. Median age was 69 years. Overall in-hospital mortality was 34.2%: 17.1% in those aged 18-49 years, 23.7% in those aged 50-64 years, 33.0% in those aged 65-74 years, and 51.0% in those aged ≥75 years (p<0.001). In particular, early death within 7days of hospitalization accounted for 60.6% (66/109). While old age (≥65 years), higher Pitt bacteremia score (≥4), and bacteremic pneumonia were independently associated with IPD mortality in all age groups, an additional mortality risk factor of immunocompromised status was identified for patients aged 50-64 years. PPSV23 serotypes accounted for 64.4% (122/189) of the pneumococcal isolates serotyped. CONCLUSIONS: This study suggests that vaccine-type IPD continues to place a substantial burden on older adults in the ROK, necessitating an effective vaccination strategy for those at higher risk.