Asunción Fenoll1, Carmen Ardanuy2, Josefina Liñares3, Emilia Cercenado4, Francesc Marco5, Ana Fleites6, María Rodríguez-Mayo7, Jose-Luis López-Hontangas8, Begoña Palop9, Ana-Isabel Aller10, Buenaventura Buendía11, Cristina Méndez12, Isabel Cifuentes12. 1. Spanish Reference Laboratory for Pneumococci, Centro Nacional de Microbiología, Madrid, Spain. 2. Microbiology Department, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain. Electronic address: c.ardanuy@bellvitgehospital.cat. 3. Microbiology Department, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain. 4. CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain. 5. Microbiology Department, Hospital Clínic, Barcelona, Spain; ISGlobal, Barcelona Ctr. Int. Health Res., Hospital Clínic - Universitat de Barcelona, Barcelona, Spain. 6. Microbiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain. 7. Microbiology Department, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain. 8. Microbiology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain. 9. Microbiology Department, Hospital Regional Universitario Carlos Haya, Malaga, Spain. 10. Microbiology Department, H. Nuestra Señora de Valme, Sevilla, Spain. 11. Microbiology Department, Hospital Universitario de La Princesa, Madrid, Spain. 12. Medical Department, Pfizer, Madrid, Spain.
Abstract
Serotypes/genotypes causing invasive pneumococcal disease (IPD) in adults are determined by vaccination strategies. The aim of this study was to assess the epidemiology of IPD in adults (≥18 years) after PCV13 introduction for children: serotypes, clonal complexes, antibiotic non-susceptibility and clinical presentations. We performed a prospective, clinical surveillance of hospitalized culture-confirmed IPDs in adults in nine Spanish hospitals (August 2010-June 2015). A total of 1087 culture-confirmed IPD episodes were included, of which 772 (71.0%) had bacteremic pneumonia (401 complicated/371 uncomplicated pneumonia), 122 (11.2%) meningitis, 102 (9.4%) non-focal bacteremia, 34 (3.1%) peritonitis and 57 (5.3%) others. The most common serotypes were: 3 (12.7%), 19A (8.5%), 8 (7.7%), 7F (6.3%), 1 (4.2%), 6C (4.2%), 11A (4.2%), 22F (4.2%) and 14 (4.0%). Vaccine types (PCV13 + 6C) caused 49.8% of IPD episodes, with a significant decrease over the 5-year period, and significant decreases in serotypes 6C and 7F. The most common genotypes were: CC180 (8.4%), CC191 (6.0%), and CC53 (5.0%). Vaccine types caused 53.9% (414/768) pneumonia episodes and 58.9% (235/399) complicated pneumonia, 53.4% IPD in adults <50 years (143/268), and 54.7% IPD in immunocompetent patients (337/616). Overall non-susceptibility was 25.9% to penicillin (1.1% for parenteral criteria), 24.9% to erythromycin and 2.7% to levofloxacin. CONCLUSIONS: Although the percentage of vaccine-types causing IPDs in adults significantly decreased, it remained high. Associations of vaccine types with pneumonia (with complicated pneumonia for specific serotypes), and immunocompetent patients point to the burden of IPD caused by PCV13 serotypes.
Serotypes/genotypes causing invasive pneumococcal disease (IPD) in adults are determined by vaccination strategies. The aim of this study was to assess the epidemiology of IPD in adults (≥18 years) after PCV13 introduction for children: serotypes, clonal complexes, antibiotic non-susceptibility and clinical presentations. We performed a prospective, clinical surveillance of hospitalized culture-confirmed IPDs in adults in nine Spanish hospitals (August 2010-June 2015). A total of 1087 culture-confirmed IPD episodes were included, of which 772 (71.0%) had bacteremic pneumonia (401 complicated/371 uncomplicated pneumonia), 122 (11.2%) meningitis, 102 (9.4%) non-focal bacteremia, 34 (3.1%) peritonitis and 57 (5.3%) others. The most common serotypes were: 3 (12.7%), 19A (8.5%), 8 (7.7%), 7F (6.3%), 1 (4.2%), 6C (4.2%), 11A (4.2%), 22F (4.2%) and 14 (4.0%). Vaccine types (PCV13 + 6C) caused 49.8% of IPD episodes, with a significant decrease over the 5-year period, and significant decreases in serotypes 6C and 7F. The most common genotypes were: CC180 (8.4%), CC191 (6.0%), and CC53 (5.0%). Vaccine types caused 53.9% (414/768) pneumonia episodes and 58.9% (235/399) complicated pneumonia, 53.4% IPD in adults <50 years (143/268), and 54.7% IPD in immunocompetent patients (337/616). Overall non-susceptibility was 25.9% to penicillin (1.1% for parenteral criteria), 24.9% to erythromycin and 2.7% to levofloxacin. CONCLUSIONS: Although the percentage of vaccine-types causing IPDs in adults significantly decreased, it remained high. Associations of vaccine types with pneumonia (with complicated pneumonia for specific serotypes), and immunocompetent patients point to the burden of IPD caused by PCV13 serotypes.
Authors: J Rodríguez-García; R Fernández-Santos; E Ruiz de Gopegui-Bordes; O Hidalgo-Pardo Journal: Rev Esp Quimioter Date: 2020-01-03 Impact factor: 1.553