Christopher Gray, United States of America

Vanderbilt University Medical Center Emergency Medicine

Author Of 4 Presentations

INVASIVE PNEUMOCOCCAL DISEASE IN ADULTS IN TENNESSEE AND GEORGIA, USA: RESULTS FROM THE PNEUMO STUDY (ID 351)

Abstract

Background

Surveillance of invasive pneumococcal disease (IPD) is important to understand the effects of direct and indirect protection from pneumococcal vaccination programs and inform vaccine development and policy.

Methods

As part of the ongoing Pneumococcal Pneumonia Epidemiology, Urine Serotyping, and Mental Outcomes (PNEUMO) study, we enrolled adults hospitalized with IPD in Nashville and Atlanta from September-2018 to August-2019. IPD was defined by isolation of Streptococcus pneumoniae from a normally-sterile site.

Results

We enrolled 25 IPD cases, including 18 (72%) pneumonia, 5 (20%) bacteremia without an identified focus, 1 meningitis, and 1 septic arthritis. Pneumococcal serotype was identified from blood culture in 20 cases, including serotypes: 35B–(3 cases), 3-(2 cases), 15A-(2 cases), 19F-(2 cases), 20-(2 cases), 23A-(2 cases), 22F, 8, 9N, 11A, 23B, 31, 35F. Median age was 62 years; 23 (92%) presented from a community residence; 12 (48%) were immunocompromised; and all had ≥1 major chronic medical condition. In-hospital outcomes: 0 deaths; 10 (40%) ICU admissions; 9 (36%) mechanical ventilation; 3 (12%) vasopressors; 3 (12%) pleural drainage procedure; 1 (4%) new renal-replacement-therapy.

Conclusions

IPD is a highly morbid disease in US adults, with most cases in this study caused by serotypes not in the current 13-valent pneumococcal conjugate vaccine.

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COGNITIVE FUNCTION FOLLOWING PNEUMOCOCCAL AND ALL-CAUSE PNEUMONIA: RESULTS FROM THE PNEUMO STUDY (ID 353)

Abstract

Background

Systemic inflammation from pneumonia may lead to acute brain dysfunction and long-term cognitive impairment, especially in older patients with severe pneumonia.

Methods

As part of the ongoing Pneumococcal Pneumonia Epidemiology, Urine Serotyping, and Mental Outcomes (PNEUMO) study, we prospectively enrolled adults hospitalized with community-acquired pneumonia. We tested for Streptococcus pneumoniae with cultures and BinaxNOW urinary antigen tests. We assessed global cognition in patients ≥50 years old with the Montreal Cognitive Assessment-Blind Adaptation (MoCA-Blind). MoCA-Blind scores range from 0 to 22 with higher scores indicating better cognition. Adults with a MoCA-Blind score <18 are considered to have cognitive impairment. We administered the MoCA-Blind instrument at enrollment when the patient was acutely ill and 6-months later by phone.

Results

At the time of this interim analysis, 150 patients had cognitive assessments completed at enrollment and 6-months, including 12 (8.0%) with pneumococcal pneumonia. Median (IQR) age was 64 (58-71) years. Cognitive impairment was common at both enrollment and 6-months later (Figure). At 6-month follow-up, 58% of pneumococcal and 52% of non-pneumococcal pneumonia patients had a MoCA-Blind score <18.

pneumo_boxplot_fig_11-30-2019.jpg

Conclusions

Hospitalization for pneumonia, including pneumococcal pneumonia, is associated with high risk of acute and persistent cognitive impairment among US adults ≥50 years old.

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