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High prevalence of multiple serotypes of pneumococci in patients with pneumonia and their associated risk factors
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 en...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BMJ Publishing Group
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9606540/ https://www.ncbi.nlm.nih.gov/pubmed/35474029 http://dx.doi.org/10.1136/thoraxjnl-2021-217979 |
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author | Dhoubhadel, Bhim Gopal Suzuki, Motoi Ishifuji, Tomoko Yaegashi, Makito Asoh, Norichika Ishida, Masayuki Hamaguchi, Sugihiro Aoshima, Masahiro Yasunami, Michio Ariyoshi, Koya Morimoto, Konosuke |
author_facet | Dhoubhadel, Bhim Gopal Suzuki, Motoi Ishifuji, Tomoko Yaegashi, Makito Asoh, Norichika Ishida, Masayuki Hamaguchi, Sugihiro Aoshima, Masahiro Yasunami, Michio Ariyoshi, Koya Morimoto, Konosuke |
author_sort | Dhoubhadel, Bhim Gopal |
collection | PubMed |
description | 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 ≥10(4)/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. |
format | Online Article Text |
id | pubmed-9606540 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-96065402022-10-28 High prevalence of multiple serotypes of pneumococci in patients with pneumonia and their associated risk factors Dhoubhadel, Bhim Gopal Suzuki, Motoi Ishifuji, Tomoko Yaegashi, Makito Asoh, Norichika Ishida, Masayuki Hamaguchi, Sugihiro Aoshima, Masahiro Yasunami, Michio Ariyoshi, Koya Morimoto, Konosuke Thorax Respiratory Infection 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 ≥10(4)/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. BMJ Publishing Group 2022-11 2022-04-26 /pmc/articles/PMC9606540/ /pubmed/35474029 http://dx.doi.org/10.1136/thoraxjnl-2021-217979 Text en © 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. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) . |
spellingShingle | Respiratory Infection Dhoubhadel, Bhim Gopal Suzuki, Motoi Ishifuji, Tomoko Yaegashi, Makito Asoh, Norichika Ishida, Masayuki Hamaguchi, Sugihiro Aoshima, Masahiro Yasunami, Michio Ariyoshi, Koya Morimoto, Konosuke High prevalence of multiple serotypes of pneumococci in patients with pneumonia and their associated risk factors |
title | High prevalence of multiple serotypes of pneumococci in patients with pneumonia and their associated risk factors |
title_full | High prevalence of multiple serotypes of pneumococci in patients with pneumonia and their associated risk factors |
title_fullStr | High prevalence of multiple serotypes of pneumococci in patients with pneumonia and their associated risk factors |
title_full_unstemmed | High prevalence of multiple serotypes of pneumococci in patients with pneumonia and their associated risk factors |
title_short | High prevalence of multiple serotypes of pneumococci in patients with pneumonia and their associated risk factors |
title_sort | high prevalence of multiple serotypes of pneumococci in patients with pneumonia and their associated risk factors |
topic | Respiratory Infection |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9606540/ https://www.ncbi.nlm.nih.gov/pubmed/35474029 http://dx.doi.org/10.1136/thoraxjnl-2021-217979 |
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