Ariel Kenig1, Gili Regev-Yochay2, Shirley Khakshoor3, Ronit Cohen-Poradosu4, Jihad Bishara5, Daniel Glikman6, Mirit Hershman-Sarafov7, Ron Dagan8, Oren Zimhony9. 1. Hadassah Medical Center, Affiliated to the School of Medicine, Hebrew University, Jerusalem, Israel. Electronic address: kenig.ariel@gmail.com. 2. Sheba Medical Center, Ramat-Gan, Affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel. Electronic address: gili.regev@sheba.health.gov.il. 3. Sheba Medical Center, Ramat-Gan, Israel. Electronic address: skhakshoor@gmail.com. 4. Tel Aviv Medical Center, Affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel. Electronic address: rcohenporadosu@gmail.com. 5. Rabin Medical Center, Petach Tikva, Affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel. Electronic address: jihadb@clalit.org.il. 6. Galilee Medical Center, Naharia, Affiliated to The Faculty of Medicine in the Galilee, Tzfat, Israel. Electronic address: Daniel.glikman@biu.ac.il. 7. Bnai Zion Medical Center, Affiliated to the Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. Electronic address: mirit.hershman@b-zion.org.il. 8. Ben-Gurion University, Beer-Sheva, Israel. Electronic address: rdagan@bgu.ac.il. 9. Kaplan Medical Center, Affiliated to the School of Medicine, Hebrew University and Hadassah, Jerusalem, Israel. Electronic address: oren_z@clalit.org.il.
Abstract
OBJECTIVES: Invasive pneumococcal disease (IPD) usually has its onset in the community (CO-IPD), but it can commence following hospitalization (HO-IPD). This study compared HO-IPD and CO-IPD cases during the implementation of the pneumococcal conjugate vaccine (PCV) program for children in Israel. METHODS: This was a nationwide retrospective cohort study of adult (age >18 years) IPD patients covering the period from the implementation of the PCV7/13 program in 2009/2010 through 2015. HO-IPD and CO-IPD were defined as IPD with onset ≥4 and ≤2 days from admission, respectively. Patient characteristics, outcome measures, serotypes, and antimicrobial susceptibility were compared for the entire cohort, followed by a matched case-control analysis. RESULTS: The study included 114 patients with HO-IPD and 2180 with CO-IPD. After matching HO-IPD to CO-IPD patients by age, sex, and comorbidities, the mortality rate and discharge to long-term care facility rate were significantly higher for HO-IPD patients than for CO-IPD patients (44.6% vs. 26.3% and 26.5% vs. 8.2%, respectively). HO-IPD isolates were less often covered by PCV13 (39.6% vs. 49.0%) and pneumococcal polysaccharide vaccine PPSV23 (56.6% vs. 71.3%) and more often resistant to penicillin (9.3% vs. 3.6%), ceftriaxone (3.8% vs. 0.75%), and levofloxacin (9.3% vs. 0.8%). CONCLUSIONS: HO-IPD was associated with higher morbidity and mortality than CO-IPD and was more often caused by non-vaccine serotypes (primarily non-PCV13 types) and antibiotic-resistant strains.
OBJECTIVES: Invasive pneumococcal disease (IPD) usually has its onset in the community (CO-IPD), but it can commence following hospitalization (HO-IPD). This study compared HO-IPD and CO-IPD cases during the implementation of the pneumococcal conjugate vaccine (PCV) program for children in Israel. METHODS: This was a nationwide retrospective cohort study of adult (age >18 years) IPD patients covering the period from the implementation of the PCV7/13 program in 2009/2010 through 2015. HO-IPD and CO-IPD were defined as IPD with onset ≥4 and ≤2 days from admission, respectively. Patient characteristics, outcome measures, serotypes, and antimicrobial susceptibility were compared for the entire cohort, followed by a matched case-control analysis. RESULTS: The study included 114 patients with HO-IPD and 2180 with CO-IPD. After matching HO-IPD to CO-IPD patients by age, sex, and comorbidities, the mortality rate and discharge to long-term care facility rate were significantly higher for HO-IPD patients than for CO-IPD patients (44.6% vs. 26.3% and 26.5% vs. 8.2%, respectively). HO-IPD isolates were less often covered by PCV13 (39.6% vs. 49.0%) and pneumococcalpolysaccharide vaccine PPSV23 (56.6% vs. 71.3%) and more often resistant to penicillin (9.3% vs. 3.6%), ceftriaxone (3.8% vs. 0.75%), and levofloxacin (9.3% vs. 0.8%). CONCLUSIONS: HO-IPD was associated with higher morbidity and mortality than CO-IPD and was more often caused by non-vaccine serotypes (primarily non-PCV13 types) and antibiotic-resistant strains.