High prevalence of multiple serotypes of pneumococci in patients with pneumonia and their associated risk factors
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ..
BACKGROUND: Multiple serotypes of pneumococci have epidemiological and clinical implications, such as the emergence of non-vaccine serotypes and the acquisition of antimicrobial resistance. Prevalence of multiple serotypes of pneumococci in adults and their risk factors are not known.
METHODS: We enrolled adult patients from age ≥15 years with radiologically confirmed pneumonia in four hospitals across Japan. Pneumococcal pneumonia was defined with a pneumococcal bacterial density of ≥104/mL in sputum by lytA quantitative PCR, and serotypes were determined. Pneumonias with a single serotype were categorised as single-serotype pneumococcal pneumonia and with two or more serotypes as multiple-serotype pneumococcal pneumonia. Multivariable logistic regression was used to assess the risk factors.
RESULTS: 3470 patients (median age 77 years, IQR 65-85) were enrolled. Pneumococcal pneumonia was identified in 476 (18.3%, n=2605) patients. Multiple serotypes were detected in 42% of them. Risk of having multiple serotypes was low among patients who had received 23-valent pneumococcal polysaccharide vaccine (PPSV23) vaccines (adjusted OR 0.51 (95% CI 0.27 to 0.94)). Proportion of non-PCV7 PPSV23 serotypes in overall distribution of multiple serotypes was 67.4% (n=324/481) compared with 46.4% (n=128/276) in that of single serotypes (p=0.001). Serotypes 5, 9N/9L, 10A, 12/22/46, 17F and 35F were associated with multiple-serotype pneumonia, and serotypes 6A/6B, 23F, 11 and 6C/6D were associated with single-serotype pneumonia. Proportion of more invasive serotypes (serotypes 1, 5, 7F, 8) was significantly higher in multiple-serotype pneumonia (p=0.001).
CONCLUSIONS: Multiple serotypes of pneumococci are common in sputum of adult patients with pneumonia. The risk of multiple-serotype pneumococcal pneumonia is lower than that of single-serotype pneumococcal pneumonia among PPSV23-vaccinated patients.
TRIAL REGISTRATION NUMBER: UMIN000006909.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - year:2022 |
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| Enthalten in: |
Thorax - (2022) vom: 26. Apr. |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Dhoubhadel, Bhim Gopal [VerfasserIn] |
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| Links: |
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| Themen: |
Bacterial infection |
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| Anmerkungen: |
Date Revised 20.02.2024 published: Print-Electronic Citation Status Publisher |
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| doi: |
10.1136/thoraxjnl-2021-217979 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM340030003 |
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| 100 | 1 | |a Dhoubhadel, Bhim Gopal |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a High prevalence of multiple serotypes of pneumococci in patients with pneumonia and their associated risk factors |
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| 500 | |a Date Revised 20.02.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status Publisher | ||
| 520 | |a © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. | ||
| 520 | |a BACKGROUND: Multiple serotypes of pneumococci have epidemiological and clinical implications, such as the emergence of non-vaccine serotypes and the acquisition of antimicrobial resistance. Prevalence of multiple serotypes of pneumococci in adults and their risk factors are not known | ||
| 520 | |a METHODS: We enrolled adult patients from age ≥15 years with radiologically confirmed pneumonia in four hospitals across Japan. Pneumococcal pneumonia was defined with a pneumococcal bacterial density of ≥104/mL in sputum by lytA quantitative PCR, and serotypes were determined. Pneumonias with a single serotype were categorised as single-serotype pneumococcal pneumonia and with two or more serotypes as multiple-serotype pneumococcal pneumonia. Multivariable logistic regression was used to assess the risk factors | ||
| 520 | |a RESULTS: 3470 patients (median age 77 years, IQR 65-85) were enrolled. Pneumococcal pneumonia was identified in 476 (18.3%, n=2605) patients. Multiple serotypes were detected in 42% of them. Risk of having multiple serotypes was low among patients who had received 23-valent pneumococcal polysaccharide vaccine (PPSV23) vaccines (adjusted OR 0.51 (95% CI 0.27 to 0.94)). Proportion of non-PCV7 PPSV23 serotypes in overall distribution of multiple serotypes was 67.4% (n=324/481) compared with 46.4% (n=128/276) in that of single serotypes (p=0.001). Serotypes 5, 9N/9L, 10A, 12/22/46, 17F and 35F were associated with multiple-serotype pneumonia, and serotypes 6A/6B, 23F, 11 and 6C/6D were associated with single-serotype pneumonia. Proportion of more invasive serotypes (serotypes 1, 5, 7F, 8) was significantly higher in multiple-serotype pneumonia (p=0.001) | ||
| 520 | |a CONCLUSIONS: Multiple serotypes of pneumococci are common in sputum of adult patients with pneumonia. The risk of multiple-serotype pneumococcal pneumonia is lower than that of single-serotype pneumococcal pneumonia among PPSV23-vaccinated patients | ||
| 520 | |a TRIAL REGISTRATION NUMBER: UMIN000006909 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a bacterial infection | |
| 650 | 4 | |a clinical epidemiology | |
| 650 | 4 | |a pneumonia | |
| 650 | 4 | |a respiratory infection | |
| 700 | 1 | |a Suzuki, Motoi |e verfasserin |4 aut | |
| 700 | 1 | |a Ishifuji, Tomoko |e verfasserin |4 aut | |
| 700 | 1 | |a Yaegashi, Makito |e verfasserin |4 aut | |
| 700 | 1 | |a Asoh, Norichika |e verfasserin |4 aut | |
| 700 | 1 | |a Ishida, Masayuki |e verfasserin |4 aut | |
| 700 | 1 | |a Hamaguchi, Sugihiro |e verfasserin |4 aut | |
| 700 | 1 | |a Aoshima, Masahiro |e verfasserin |4 aut | |
| 700 | 1 | |a Yasunami, Michio |e verfasserin |4 aut | |
| 700 | 1 | |a Ariyoshi, Koya |e verfasserin |4 aut | |
| 700 | 1 | |a Morimoto, Konosuke |e verfasserin |4 aut | |
| 700 | 0 | |a Adult Pneumonia Study Group-Japan (APSG-J) |e verfasserin |4 aut | |
| 700 | 1 | |a Abe, Masahiko |e investigator |4 oth | |
| 700 | 1 | |a Chikamori, Masayuki |e investigator |4 oth | |
| 700 | 1 | |a Furumoto, Akitsugu |e investigator |4 oth | |
| 700 | 1 | |a Hamashige, Naohisa |e investigator |4 oth | |
| 700 | 1 | |a Hosokawa, Naoto |e investigator |4 oth | |
| 700 | 1 | |a Ito, Hiroyuki |e investigator |4 oth | |
| 700 | 1 | |a Kakiuchi, Satoshi |e investigator |4 oth | |
| 700 | 1 | |a Kaneko, Norihiro |e investigator |4 oth | |
| 700 | 1 | |a Katoh, Shungo |e investigator |4 oth | |
| 700 | 1 | |a Katsurada, Naoko |e investigator |4 oth | |
| 700 | 1 | |a Kitashoji, Emi |e investigator |4 oth | |
| 700 | 1 | |a Matsuki, Kei |e investigator |4 oth | |
| 700 | 1 | |a Nakaoka, Hiroshi |e investigator |4 oth | |
| 700 | 1 | |a Nakashima, Kei |e investigator |4 oth | |
| 700 | 1 | |a Otsuka, Yoshihito |e investigator |4 oth | |
| 700 | 1 | |a Sando, Eiichiro |e investigator |4 oth | |
| 700 | 1 | |a Shibui, Kaori |e investigator |4 oth | |
| 700 | 1 | |a Shimazaki, Takaharu |e investigator |4 oth | |
| 700 | 1 | |a Suzuki, Daisuke |e investigator |4 oth | |
| 700 | 1 | |a Takaki, Masahiro |e investigator |4 oth | |
| 700 | 1 | |a Tanaka, Kenzo |e investigator |4 oth | |
| 700 | 1 | |a Tochitani, Kentaro |e investigator |4 oth | |
| 700 | 1 | |a Tsuchihashi, Yoshiko |e investigator |4 oth | |
| 700 | 1 | |a Wakabayashi, Takao |e investigator |4 oth | |
| 700 | 1 | |a Watanabe, Kiwao |e investigator |4 oth | |
| 700 | 1 | |a Yoshida, Lay-Myint |e investigator |4 oth | |
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