Abstract
We studied changes in serotype distribution and antimicrobial susceptibility in adult pneumococcal pneumonia in Spain (2011–2019). Among 895 pneumococci collected (433 bacteremic [BPP] and 462 non-bacteremic [non-BPP]), serotypes 3 (17%), 19A (10%), 8 (6.7%) and 11A (6.7%) were the most frequent. Serotypes 16F, 19A and 24F were associated with old people (≥65) and serotypes 4, 7F, 8, 12F and 19F to young adults. Serotypes 12F, 24F and 1 were significantly more frequent in BPP and serotypes 11A, 23A and 19F in non-BPP. Amoxicillin resistance was higher in non-BPP (17% vs. 11%) while penicillin non-susceptibility (37% vs. 24%) and macrolide resistance (29% vs. 14%) were higher in older adults. In the period 2017–2019, the vaccine coverages were: 32% (PCV13), 39% (PCV15), 65% (PCV20) and 69% (PPV23). Differences were found in serotype composition and antimicrobial resistance by age and type of infection. The maintenance of serotype 3 as a leading cause of adult pneumococcal pneumonia and the increase in highly invasive (serotype 8) or antimicrobial-resistant (serotype 11A) serotypes is worrisome. Further studies will be required to analyse the impact of the upcoming broader conjugate vaccines.
Highlights
IntroductionLower respiratory tract infections are an important cause of severe disease worldwide
The introduction of pneumococcal conjugate vaccines (PCVs) has led to an overall decrease in the incidence of invasive pneumococcal disease (IPD), but an increase in disease caused by non-vaccine serotypes has been detected [14]
In Spain, after the PCV13 introduction in 2010, there has been a significant decrease in the incidence of invasive infections caused by PCV13 serotypes, except for serotype 3 [15]
Summary
Lower respiratory tract infections are an important cause of severe disease worldwide. Streptococcus pneumoniae is an important cause of invasive and non-invasive diseases [1]. It is among the leading causes of pneumonia in adults [2] with a significant impact on hospital admissions, morbidity/mortality and medical costs [3]. The capsule is the main pneumococcal virulence factor and the basis for vaccine development. Vaccines are useful to prevent pneumococcal diseases, but the diversity of the capsular polysaccharide (at least 100 pneumococcal capsular types described) limits its effectiveness. The introduction of pneumococcal conjugate vaccines (PCVs) in children changed the epidemiology of pneumococcal diseases worldwide.
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