Background

The number of deaths due to pneumococcal pneumonia (PP) in the United States (U.S.) is not well defined. The objectives of this study were to define mortality of PP in the city of Louisville, Kentucky and to estimate the number of deaths in hospitalized patients with PP in the U.S.

Methods

In hospitalized patients with community-acquired pneumonia (CAP), urinary antigen detection of 24 S. pneumoniae serotypes (UAD-24) was performed. This UAD-24 study was nested in a prospective population-based cohort study of all adult residents in Louisville, hospitalized with CAP from 6/1/14 to 5/31/16. Louisville PP mortality was evaluated early (during hospitalization and at 30-days after hospitalization) and late (6-months and 1-year after hospitalization) and US number of deaths were estimated.

Results

A total of 708 patients with PP were evaluated. PP mortality was 3.7% during hospitalization, 8.2% at 30-days, 17.6% at 6-months, and 25.4% at 1-year. Number of deaths in the U.S. were: 8,323 (95%CI:5,468-12,091) during hospitalization, 18,619 (95%CI:14,231-23,711) at 30-days, 39,807 (95%CI:33,506-46,502) at 6 months, and 57,626 (95%CI:50,130-64,940) at 1-year.

Conclusions

In hospitalized patients, PP is associated with significant early and late mortality. Approximately 1 out of 4 hospitalized adult patients with PP will die within 1-year.

Background

Worldwide up to 30% of patients admitted to hospitals due to community-acquired pneumonia (CAP) develop major-adverse-cardiovascular events (MACE). Importantly, patients who develop MACE have a higher risk of dying during acute hospitalization and up to 10 years thereafter. Streptococcus pneumoniae (Spn) is the only etiological agent linked independently to MACE. However, there is no data regarding which Spn serotype is more associated with MACE in humans.

Methods

This is an observational, multicentric, retrospective cohort study conducted through the Health Secretary of Bogotá (HSB), Colombia. All patients with the diagnosis of invasive pneumococcal disease (IPD), reported in Bogota to the HIB between 2012 and 2019 were included. Serotyping was carryout at the HIB. MACE were defined as new/worsening heart failure, new/worsening arrhythmias, and/or myocardial infarctions. A multivariate analysis was performed.

Results

A total of 314 patients with IPD were included. 22.6% (71/314) developed MACE. As previously described, patients were older and with more comorbid conditions. However, patients with Spn serotype 3 were independently associated with MACE after adjusting for disease severity and comorbid conditions (OR 2.20; 95%CI 1.02, 4.76).

Conclusions

In patients admitted due to IPD, Spn serotype 3 is independently associated with MACE. Further molecular characterization and experiments are needed to prove causality.

Background

Pneumococcal disease (PD) case-fatality rate (CFR) in Costa Rica has being reported higher (8-30%) than in literature (3-22%).

Methods

Descriptive study of adult cases with culture-positive PD seeking care at two tertiary care hospitals in Costa Rica between 2014-2018. Information on demographics, clinical characteristics and outcomes was analyzed for each case.

Results

282 culture-positive PD cases were included. CFR is consistently higher in all risk groups among ≥ 60 y/o patients OR 2.31 [IC95 1.38-3.89].

Log-rank analysis showed an unequal 30-day mortality in adults ≥ 60 y/o (p=0.012) but no differences in risk related groups (p=0.91).

Conclusions

PD CFR vary between age and risk groups in Costa Rica. Across all risk groups, elder adults have the most risk of dying following PD. There is a similar mortality rate among all ages high-risk patients and at-risk patients. Prevention strategies to reduce the ongoing burden of mortality from PD are needed, especially for elderly patients.

Background

The study objective was to determine the prevalence of serotypes and coverage provided by currently licensed and next generation pneumococcal conjugate vaccines (PCVs) in adults hospitalized with community-acquired pneumonia (CAP) in the United States.

Methods

Hospitalized adults aged ≥18 years with radiologically-confirmed (CXR+) CAP were enrolled from 10 U.S. cities between October 2013 and September 2016. S. pneumoniae isolates cultured from normally-sterile standard-of-care specimens were serotyped by Quellung. Urine was tested using BinaxNOW® and a serotype-specific urine antigen detection (UAD) assay that detects serotypes contained in PCV13 plus 6C (highly-related to 6A), PCV15 (PCV13 serotypes, 22F, and 33F), PCV20 (PCV15 serotypes, 8, 10A, 11A, 12F, and 15B plus 15C (highly-related to 15B)), and non-PCV serotypes 2, 9N, 17F, and 20. Coverage was calculated as the percent of CXR+CAP participants positive for a serotype in PCV13, PCV15, and PCV20.

Results

Of 15,572 enrolled participants, 12,055 with CXR+CAP were included in the analysis; 52.7% (n=6347) were ≥65 years. Coverage of CXR+CAP varied by PCV formulation (Table). About 1% of CXR+CAP was due to serotypes 2, 9N, 17F, and 20 combined.

Conclusions

Compared to PCV13, PCV20 increased coverage of CXR+CAP due to PCV serotypes by 71% (18-64 years) and 64% (≥65 years).

Background

Incidence of Invasive pneumococcal disease (IPD) depends on numerous factors, including vaccine undertake, geographic location, and serotype prevalence. There is limited data about the incidence of Streptococcus pneumoniae (Spn), serotype distribution, and clinical characteristics of adults hospitalized due to IPD in Colombia. Thus, this study will attempt to bridge this gap in the literature.

Methods

This is an observational, retrospective, citywide study conducted between 2012 and 2019 in Bogotá, Colombia. We analyzed, reported positive cases of IPD. Importantly, Bogotá represents approximately 75% of the Colombian population. Strains were isolated in each hospital and typified in a centralized laboratory. The objectives included assessment of Spn serotype distribution, clinical diagnosis, mortality, ICU admission, and need for mechanical ventilation.

Results

A total of 314 patients with IPD were included, 54.8% male. The leading cause of IPD was pneumonia (33%), followed by meningitis and sepsis. The most prevalent serotypes were 19A (13.1%) and 3 (12.4%). The overall hospital mortality was 30%. Moreover, 65.6% were admitted to the ICU, 44.9% required invasive mechanical ventilation, and 5.1% non- invasive mechanical ventilation.

Conclusions

Pneumococcal pneumonia continues to be the most prevalent cause of IPD. Serotypes 19A and 3 are the leading cause of IPD in Colombian adults.

Background

Streptococcus pneumoniae (Spn) is the leading cause of community-acquired pneumonia (CAP) and bacterial meningitis in adults. Recent studies have shown that up to 30% of patients admitted due to pneumococcal CAP develop major adverse cardiovascular events (MACE, i.e., new/worsening arrhythmia, new/worsening heart failure, and myocardial infarction). However, it is unknown whether MACE could also be identified in patients with pneumococcal meningitis.

Methods

In this observational, multicentric retrospective study. We analyzed medical records from adult patients with invasive pneumococcal disease (IPD) reported in a surveillance program across all hospitals in Bogotá, Colombia, between 2012 and 2019. Pneumococcal meningitis was confirmed by the identification of Spn in blood cultures and/or cerebrospinal fluid cultures and clinical presentation. Adverse cardiac outcomes were blinded evaluated in each case.

Results

From a total of 314 patients with microbiological Spn isolation, 19.7% (62/314) were diagnosed with pneumococcal meningitis. Out of the 62 patients evaluated, 10 (16%) developed MACE, 8.1% (5) new/worsening heart failure, 6.5% (4) new/worsening arrhythmia, and 3.2% (2) myocardial infarction.

Conclusions

To our knowledge, this is the first clinical study showing that patients with pneumococcal meningitis could be at risk of MACE as reported in pneumococcal CAP. Further studies are needed to characterize patients at risk better.