Abstract
Community-acquired pneumonia (CAP) caused by Streptococcus pneumoniae is a substantial cause of morbidity and mortality among older adults. This study estimated incidences of CAP, chest x-ray-confirmed CAP (CXR+CAP), S pneumonia- positive CAP, S pneumonia-positive CXR+CAP, and S. pneumoniae serotype distribution among 46,000 at-risk adults aged ≥ 50 years residing in Chrzanów County, Poland. From January 2010 to January 2012, all facilities providing ambulatory and inpatient care enrolled all consenting resident patients with suspicion of CAP. Chest x-rays, urine, blood, and sputum samples were analyzed. Annualized incidence rates were determined. Presence of S pneumonia-positive CAP and/or S. pneumoniae serotype distribution was determined using the urine antigen detection assay (capable of detecting the serotypes in the 13-valent pneumococcal conjugate vaccine [PCV13]), BinaxNOW®, and/or microbiology cultures. Among 5055 enrolled patients, 1195 (23.7%) were diagnosed with CAP and 1166 (23.4%) had CXR+CAP. S. pneumoniae was detected in 144 (12.1%) and 131 (11.2%) patients from the CAP and CXR+CAP cohorts, respectively. Annualized incidence rates of CAP, CXR+CAP, S pneumonia-positive CAP, and S. pneumonia-positive CXR+CAP were 12.8, 12.5, 1.6, and 1.4 per 1000 residents, respectively. Among CXR+CAP patients, 39.7% were aged 50 to 64 years and 60.3% were aged ≥ 65 years. Incidence rates generally increased with age. The most common serotypes in S. pneumoniae-positive CXR+CAP patients were 3 (n = 15), 23F (n = 10), 18C (n = 9), and 9V (n = 6). CAP due to PCV13 serotypes is a source of morbidity among adults >50 years and may be reduced by greater access to pneumococcal vaccines.
Highlights
Community-acquired pneumonia (CAP) caused by Streptococcus pneumoniae is a substantial cause of morbidity and mortality among older adults
The criteria used to select the surveillance area included a well-defined population of eligible patients; definable and limited number of study hospitals and outpatient clinics; high-quality in-hospital clinical microbiology testing; low rates (< 5% per year) of migration; ability to diagnose and treat adults with severe disease associated with CAP; feasibility of obtaining information about healthcare use and healthcare system description; Rafal Harat et al, CAP in older Polish adults and ability of the investigator to implement and sustain CAP population-based surveillance during the course of a 2-year study period
5055 patients were enrolled in the present study; 6 subjects did not have respiratory illness which resulted in a total of 5049 patients, of whom 1195 (23.7%) were diagnosed with CAP (Table 1) and 1166 (23.4%) had chest x-ray−confirmed CAP (CXR+CAP)
Summary
Community-acquired pneumonia (CAP) caused by Streptococcus pneumoniae is a substantial cause of morbidity and mortality among older adults. This study estimated incidences of CAP, chest x-ray−confirmed CAP (CXR+CAP), S pneumoniae-positive CAP, S pneumoniae-positive CXR+CAP, and S. pneumoniae serotype distribution among 46,000 at-risk adults aged ≥ 50 years residing in Chrzanów County, Poland. Annualized incidence rates of CAP, CXR+CAP, S pneumoniae-positive CAP, and S. pneumoniae-positive CXR+CAP were 12.8, 12.5, 1.6, and 1.4 per 1000 residents, respectively. The most common serotypes in S. pneumoniae-positive CXR+CAP patients were 3 (n = 15), 23F (n = 10), 18C (n = 9), and 9V (n = 6). 2, pages 95–103 to 2009, all-cause, inpatient CAP increased with age, with rates of 1.5, 4.0, 8.8, and 16.8 per 1000 adults aged 50 to 64, 65 to 74, 75 to 84, and 85 to 99 years, respectively [10]; the case fatality rate for patients ≥ 50 years with CAP was 18.6% [10]. The most common S. pneumoniae serotypes were 1, 3, 4, 9V, 9N, 12F, 14, 19F, and 23F in those ≥ 55 years of age [11]
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