Pneumococcal Infection In Adults Research Articles

Association between celiac disease and pneumococcal infections in hospitalized pediatric patients in the United States.

Celiac disease (CD) is an immune-mediated enteropathy that is associated with pneumococcal infections in adults. The objective of this study is to evaluate the association between CD and pneumococcal infections in hospitalized pediatric patients in the United States (US). The triennial Healthcare Cost and Utilization Project Kids' Inpatient Database was used in a retrospective analysis of children hospitalized in the US from 1997 to 2019. Billing codes were used to define patients with CD who were admitted with Streptococcus pneumoniae speciated infections or an infection commonly caused by S. pneumoniae. A multivariable logistic regression model was used to quantify increased odds of various types of infections for patients with CD. Among 55,080,914 pediatric hospital admissions, 15,412 were identified with CD, and 1,722,872 were admitted with the specified infections. CD was associated with both pneumococcus speciated infections (odd ratio [OR], 2.16, 95% confidence interval [CI], 1.38-3.38) and infections commonly caused by S. pneumoniae (OR, 1.78; 95% CI, 1.61-1.96): pneumonia (OR, 1.70; 95% CI, 1.53-1.89), sinusitis (OR, 2.41, 95% CI, 1.76-3.30), and bacteremia (OR, 2.12; 95% CI, 1.56-2.88). Patients with CD had a significantly longer length of stay (p < 0.001) and a greater cost of hospitalization (p < 0.001) with pneumococcus associated infections. CD is associated with an increased risk of both pneumococcus speciated and pneumococcus-associated infections requiring hospitalization. CD admissions are associated with longer hospital stays and higher costs without increased risk of death. Routine pneumococcal vaccinations are strongly recommended for pediatric patients with CD.

Serotype distribution of Streptococcus pneumoniae and pneumococcal vaccine coverage in adults in Turkey between 2015 and 2018

Objective To evaluate the serotype distribution and antibiotic resistance in pneumococcal infections in adults and to provide a perspective regarding serotype coverage of both current and future pneumococcal vaccines. Patients and methods This passive surveillance study was conducted with the Streptococcus pneumoniae strains isolated from the specimens of patients with pneumonia (materials isolated from bronchoalveolar lavage), bacteraemia, meningitis, pleuritis and peritonitis between 2015 and 2018. Serogrouping and serotyping were performed by latex particle agglutination and by conventional Quellung reaction using commercial type-specific antisera, respectively. The strains were analysed for penicillin, cefotaxime, erythromycin and moxifloxacin susceptibilities by E-test. Results In the whole study group (410 samples from adults aged ≥18 years), the most frequent serotypes were 3 (14.1%), 19 F (12%) and 1 (9.3%). The vaccine coverage for PCV13, PCV15, PCV20 and PPV23 was 63.9%, 66.6%, 74.1% and 75.9%, respectively, in all isolates. Penicillin non-susceptibility in invasive pneumococcal disease (IPD) was 70.8% and 57.1% in the patients aged <65 and ≥65 years, respectively. About 21.1% and 4.3% of the patients with and without IPD had cefotaxime resistance. Non-susceptibility to erythromycin and moxifloxacin was 38.2% and 1.2%, respectively. Conclusions The results revealed that novel PCV vaccines may provide improved coverage as compared with the currently available vaccine, PCV13. The significant antibiotic resistance rates imply the need to extend the serotype coverage of the vaccines. Continuing the surveillance in pneumococcal diseases is critical to explore the serotype distribution and incidence changes of IPD cases in the population and to inform policy makers to make necessary improvements in the national immunization programmes. Key messages This multicentre study demonstrated the most recent serotype distribution and antibiotic resistance in adult population in Turkey. Shifting from PCV13 to novel conjugated vaccines will significantly increase the coverage. Continuing the surveillance in pneumococcal diseases is critical to explore the serotype distribution changes and the incidence of cases with invasive pneumococcal disease in the population.

A comprehensive overview of pneumococcal vaccination recommendations for adults in South Africa, 2022.

Pneumococcal infections remain a common global cause of significant morbidity and mortality. The first recommendations for adult pneumococcal vaccination, published in South Africa in 1999, contained information only on the 23-valent polysaccharide vaccine (PPV23). With the introduction of the 13-valent pneumococcal conjugate vaccine (PCV13) for use in adults and the perceived uncertainty that most clinicians had regarding use of these vaccines in adults, these vaccine recommendations were updated in 2022. A Working Group, which consisted of individuals in various fields of medical practice in South Africa, who were from different areas of the country, and included clinicians from both the public and private sectors, was assembled to revise the recommendations. The expertise of the participants varied widely, dependent on their training and specialty, and encompassed different organ systems, disease conditions, and/or practice types. Each participant was allocated a different section, based on their expertise, for which they were required to do an extensive review of the current literature and write their section. The entire working group then reviewed the complete document several times, following additional comments and recommendations. This update contains recommendations for the use of both PPV23 and PCV13, either alone, or in sequence, both in vaccine naïve and in previously vaccinated individuals. It includes both age and risk categories, and encompasses the elderly (≥65 years), as well as younger adults (<65 years) with comorbid conditions or with high-risk conditions and/or immunocompromise. It is hoped that this review and its associated vaccine recommendations will clarify for clinicians, from all spheres of practice in South Africa, how, where, and when pneumococcal vaccines should be used in adults, with the ultimate goal of significantly increasing the appropriate use of these vaccines, in order to decrease the substantial morbidity and mortality associated with pneumococcal infections in adults in South Africa. Furthermore, it is hoped that this review of local epidemiological data and the manner in which this information was interpreted in the development of these local vaccine recommendations, could be used as an example for other regions of the world, to tailor their recommendations to locally available epidemiological data.

Official statements of the expert meeting on pneumococcal vaccination in adults in Russia

The purpose of the meeting is to obtain an opinion on approaches and recommendations for vaccine prevention of pneumococcal infections in adults.

Vaccination against pneumococcal infection in adults from risk groups

In Russia starting from 2014, adults from risk groups are vaccinated against pneumococcal infection in accordance with the vaccination calendar based on epidemic indications. However, data collected by the Epidemiological Surveillance for Vaccine Prevention do not allow to judge about the protection of adult population against pneumococcal disease, as there is no information on the coverage of risk groups. The objective : to analyze the coverage of adult population from risk groups with vaccination against pneumococcal infection. Subjects and methods. The number and groups of adults vaccinated against pneumococcal infection were provided by the executive authorities in charge of health care in the Russian Federation. Data for 4 years were collected (201 5-2 018). The information was received from 79 regions of the Russian Federation. Descriptive statistics methods were used to analyze the coverage in age and occupational risk groups and people with chronic diseases. Results . The main groups of adults vaccinated against pneumococcal infection were the following: patients with chronic diseases (55%, including 27.5% of patients with chronic lung disease), conscripts (30%), various occupational risk groups (11%). The remaining risk groups accounted for less than 5% of vaccinations. The maximum coverage was achieved among adults with chronic lung disease (15.1%). Among patients with chronic no n-p ulmonary diseases, coverage was the following: patients with liver diseases – 4%, cardiovascular diseases – 3.8%, endocrine system – 2.8%, immunodeficiencies – 1%. In other groups of chronic patients, coverage was even lower. Among adults with occupational risk factors and staying in special conditions, the maximum vaccination coverage was achieved among conscripts (67.4%). Vaccination in other categories of occupational risk was performed in a small number of people; among health workers, it was 4.9%, among employees of educational organizations of open type (schools, kindergartens, etc.) it made 3.1%.

The effect of pneumococcal immunization on total and antigen-specific B cells in patients with severe chronic kidney disease

BackgroundWhile the 23-valent pneumococcal polysaccharide vaccine (PPV23) is routinely used in Canada and some other countries to prevent pneumococcal infection in adults with chronic kidney disease (CKD), patients develop a suboptimal antibody response to PPV23 due to their immune dysfunction. The 13-valent pneumococcal conjugate vaccine (PCV13) has superior immunogenicity in some categories of immunocompromised adults; however, its effect on the immune response in CKD patients has only been addressed by two recent studies with conflicting results. The effect of PPV23 or PCV13 on B cells in these patients has not been previously studied. We studied the absolute numbers and proportions of B cells and subpopulations in two groups of adult patients with severe CKD pre- and 7 days post-immunization with PCV13: pneumococcal vaccine naïve and previously immunized with PPV23 (over one year ago).ResultsPPV23 immunized patients had significantly lower proportions and absolute numbers of class switched memory (CD19 + CD27 + IgM-), as well as lower absolute numbers of IgM memory (CD19 + CD27 + IgM+) and class switched B cells (CD19 + CD27-IgM-) compared to PPV23 naïve patients. Following PCV13 immunization, the differences in absolute numbers of B-cell subpopulations between groups remained significant. The PPV23 immunized group had higher proportions of CD5- B cells along with lower proportions and absolute numbers of CD5+ B cells compared to PPV23 naïve patients both pre- and post-immunization with PCV13. However, previous PPV23 immunization did not have a noticeable effect on the numbers of total IgG or serotype 6B and 14 specific antibody-secreting cells detected 7 days post-immunization with PCV13. Nevertheless, fold increase in anti-serotype 14 IgG concentrations 28 days post-PCV13 was greater in PPV23 naïve than in previously immunized patients.ConclusionsThe results suggest that immunization with PPV23 may result in long-term changes in B-cell subpopulations such as increased prevalence of CD5- B cells and decreased prevalence of class switched memory B cells in the peripheral blood. Because previous immunization with PPV23 in patients with CKD is associated with a significant decrease in the total class switched memory B cells in response to subsequent immunization with PCV13, this may reduce PCV13 immunogenicity in the setting of PPV23 followed by PCV13.Trial registrationRegistered February 24, 2015 at ClinicalTrials.gov (NCT 02370069).

Surveillance of Invasive Pneumococcal Infections in Adults (Excluding Meningitis)

Surveillance of Invasive Pneumococcal Infections in Adults (Excluding Meningitis)

Federal Clinical Guidelines on Preventive Vaccination Against Pneumococcal infections in Adults

The Federal Guidelines on preventive vaccination against pneumococcal infections in adults were developed by experts of Russian Respiratory Society and National Non-profit Association of Specialists for Control Healthcare-Associated Infections. Studies published during the previous 5 years were selected from EMBASE, MEDLINE , and PubMed databases and the Cochrane library and were reviewed by independent experts with consideration of practical physicians’ opinions. The results of this analysis underlay the guidelines. Quality of evidence and strength of recommendations were assessed according to widespread criteria. The guidelines include epidemiology, social burden, pathogenesis, and clinical course of pneumococcal infections, characteristic of vaccines used to prevent pneumococcal infections and special considerations of preventive vaccination in patients with comorbidity and in risk groups. The experts discussed efficacy of preventive vaccination and postvaccinal reactions. The guidelines meet the requirements of Healthcare Ministry of Russian Federation.

Vaccination against pneumococcal infections in adults

The following key issues of pneumococcal infection prophylaxis were discussed during the expert council: incidence rates of community-acquired pneumococcal pneumonia and other pneumococcal infections, local epidemiological data, increases in antimicrobial resistance and pneumococcal serotypes substitution, current international and Russian clinical guidelines, practical approaches, and pneumococcal vaccination coverage of adult population in the Russian Federation. The agreement between the experts about a need to distinguish the use of conjugate vaccines and polysaccharide vaccines in different subpopulations has been achieved.

Study of Invasive Pneumococcal Infection in Adults with Reference to Penicillin Resistance.

Background:Invasive pneumococcal infections often prove rapidly fatal, even where good medical treatment is readily available. In developed countries, up to 20% of people who contract pneumococcal meningitis die; however, in developing world, mortality is closer to 50%, even among hospitalized patients. The World Health Organization estimated 600,000–800,000 adult deaths each year from pneumococcal pneumonia, meningitis, and sepsis.Aims:This study aims to estimate isolation rate of invasive pneumococcal infection in adults, to determine the antimicrobial susceptibility profile of Streptococcus pneumoniae isolates and to study the associated risk factors.Materials and Methods:A total of 120 patients with suspected invasive infection such as meningitis, septicemia, and pleural effusion, were included in the study. Various clinical specimens such as pus, cerebrospinal fluid, and other sterile body fluids were processed for isolation and identification of S. pneumoniae. Kirby–Bauer disc diffusion method was performed to determine the antimicrobial susceptibility profile. Minimum inhibitory concentration test was performed to determine the penicillin resistance.Results:Of 120 patients, 40 (33.33%) cases were proven by culture to have an invasive pneumococcal infection. The most common clinical condition observed was meningitis followed by pneumonia with pleural effusion and sepsis. Pneumococcal isolates exhibited 40% resistance to cotrimoxazole and 12.73% to chloramphenicol. Two meningeal isolates exhibited penicillin resistance. Comorbidities observed in 21 (52.5%) cases were mainly Diabetes mellitus, smoking, and alcoholism.Conclusions:Invasive pneumococcal infection has poor prognosis and penicillin-resistant strains have become increasingly common. This study emphasizes the importance of judicious use of antibiotics, especially to refrain their use in mild self-limiting upper respiratory infections.

The effectiveness of pneumococcal polysaccharide vaccine 23 (PPV23) in the general population of 50 years of age and older: A systematic review and meta-analysis

Two pneumococcal vaccines currently exist and have been recommended for the prevention of pneumococcal infection in adults 65 years of age and older: the 23-valent polysaccharide (PPV23) and the conjugate 13-valent (PCV13) vaccine. ObjectiveTo evaluate and summarize the results from all studies reporting on the vaccine effectiveness of PPV23 in preventing invasive pneumococcal disease (IPD) and community-acquired pneumonia (CAP) in individuals over the age of 50. MethodsSystematic database searches were completed in PubMed, Medline, Embase, CINAHL, Web of Science, and Cochrane. Google Scholar and hand searches of seminal articles and past systematic reviews were employed. Studies were included if they independently evaluated the effect of PPV23 on IPD and/or CAP in adults (50+). Data extraction and quality assessment were both completed independently by two researchers. Quality was assessed using the National Advisory Committee on Immunization methodology for quality assessment. All conflicts were resolved by consensus. ResultsThe vaccine effectiveness for PPV23 in preventing IPD was 50% (95% CI: 21%–69%) for cohort studies and 54% (95% CI: 32%–69%) for case-control studies. The VE estimates for CAP were 4% (95% CI: -26%–26%) for trials, 17% (95% CI: -26%–45%) for cohort studies, and 7% (95% CI: -10%–21%) for case-control studies. ConclusionsThe vaccine effectiveness of PPV23 in preventing IPD and all-cause CAP was consistent with past systematic reviews and similar to the estimates that were reported in the CAPiTA trial evaluating the vaccine effectiveness of PCV13. Consistent benefits were also reported across ecological studies and reports of surveillance data for the general population 50 years and older. The results suggests that the current practice of vaccinating the adults 65 years of age and older with PPV23 would have similar benefits to PCV13 in preventing potential cases of all-serotype IPD and all-cause CAP.

Molecular Epidemiology of Pneumococcal Infections in Adults and Children From the Kansas City Area Between 2010 and 2013

Molecular Epidemiology of Pneumococcal Infections in Adults and Children From the Kansas City Area Between 2010 and 2013

Lung abscess due to Streptococcus pneumoniae: a case series and brief review of the literature.

Anaerobes used to be the most common cause of community-acquired lung abscess, and Streptococcus species used to be the second most common cause. In recent years, this has been changing. Klebsiella pneumoniae is now an increasing cause of community- acquired lung abscess, but Streptococcus species continue to be major pathogens. Necrotizing pneumonia has generally been regarded as a rare complication of pneumococcal infection in adults. Type 3 Streptococcus pneumoniae was the single most common type implicated in necrosis; however, many other serotypes were implicated. This entity predominately infects children, but is present also in adults. Lung abscess in adults due to Streptococcus pneumoniae is not common. In this regard we present a case series of pulmonary cavitation due to Streptococcus pneumoniae and discuss the possible pathogenic mechanism of the disease.

Vaccines for preventing pneumococcal infection in adults. Summary of the evidence and implications for public health programmes

An update of a Cochrane systematic review summarised the evidence for the efficacy of pneumococcal polysaccharide vaccines (PPVs) from randomized controlled trials (RCTs) or quasi-RCTs that compared PPV with placebo, control vaccines or no intervention; and from non-RCTs that assessed pneumococcal vaccine effectiveness against sterile site, culture confirmed IPD where the trial design allowed for the control of important confounding factors (case–control and cohort studies). Of 25 included studies, 18 were RCTs including 64,852 participants and seven were non-RCTs – five case–control studies and two cohort studies including 62,294 participants; the non-RCTs contributing outcomes for culture-confirmed invasive pneumococcal disease (IPD) only.The review found consistently strong evidence that the vaccine is effective in preventing the rarer outcome of invasive pneumococcal disease. Evidence from the included studies indicates vaccination might not afford as much protection in adults with chronic illness as it does for healthy adults. The available evidence did not demonstrate that pneumococcal polysaccharide vaccines prevent pneumonia (of all causes) or mortality in adults. This review did not consider adverse events.

Risk factors and clinical significance of invasive infections caused by levofloxacin-resistant Streptococcus pneumoniae

PurposeFluoroquinolones are recommended for the treatment of pneumonia. The recognition of risk factors for invasive levofloxacin-resistant Streptococcus pneumoniae is important for the design of treatment.MethodsA retrospective review of cases of invasive pneumococcal infections in adults was undertaken. Epidemiologic data, predisposing factors, clinical variables, and outcome were recorded from previously established protocols. Antimicrobial susceptibility was determined by disk diffusion and the Etest method. Serotyping was performed by latex agglutination and Quellung reaction.ResultsTwenty patients with infection caused by levofloxacin-resistant pneumococci [minimum inhibitory concentration (MIC) ≥2 μg/ml] were compared with 102 patients harboring levofloxacin-susceptible strains; 80 % of levofloxacin-resistant pneumococci were resistant to ≥3 antibiotics but susceptible to penicillin. Most levofloxacin-resistant strains (80 %) belonged to serotype 8. In comparison, only 8 % of levofloxacin-susceptible pneumococci belonged to serotype 8. In the multivariate analysis, residence in public shelters [odds ratio (OR) 26.13; p 0.002], previous hospitalization (OR 61.77; p < 0.001), human immunodeficiency virus (HIV) infection (OR 28.14; p = 0.009), and heavy smoking (OR 14.41; p = 0.016) were associated with an increased risk of infection by levofloxacin-resistant pneumococci. Mortality caused by levofloxacin-resistant and levofloxacin-susceptible pneumococci was 35 and 14 %, respectively. Among HIV-positive individuals infected with levofloxacin-resistant pneumococci 44 % died, but only 12.5 % of HIV-positive patients with levofloxacin-susceptible strains died.ConclusionsWe observed the emergence of serotype 8 as the main cause of invasive disease caused by levofloxacin-resistant S. pneumoniae. HIV-positive patients seem to be prone to infection caused by multidrug-resistant serotype 8 and have a high mortality rate.

A nationwide surveillance of invasive pneumococcal disease in adults in Israel before an expected effect of PCV7

Pneumococcal infections in adults vary in severity and incidence is affected by childhood vaccination policy. Here, we try to define the host determinants and the interaction with specific serotypes that result in invasive pneumococcal disease (IPD) before an expected effect of pneumococcal conjugate vaccines.A nationwide active surveillance was initiated on July 2009, at the time of national implementation of PCV7 in Israel. The surveillance included all 27 laboratories and medical centers performing blood cultures in Israel, providing all blood and CSF pneumococcal isolates from persons ≥18y. Capture-recapture method assured that >95% of all cases were reported. IPD outcome and medical history were recorded and isolates were serotyped. Four hundred and sixty IPD cases were reported (annual incidence [/100,000] of 9.25). Incidence increased with age, from 2.6 among 18–34y to 66.8 among ≥85y. The most common diagnosis was pneumonia (72.4%), followed by bacteremia with no apparent focus (20.2%). Case fatality rate increased with age and number of comorbidities (34.5% for ≥75y or those with ≥3 comorbidities vs. 9.2–11.2% among <65y or those with no comorbidities; p=0.015). Variables independently associated with mortality were: age ≥75, chronic renal failure, malignancy, neurosurgery, alcohol abuse, multi-lobar pneumonia and sepsis with no apparent focus.The predominant serotypes in patients 18–49y were 1, 5, 8, 7F and 9V (constituting 56.3% in this age-group vs. 11.9% in ≥75y; p<0.01). The predominant serotypes among patients ≥75y were 3, 19A, 23F and 14 (40.3% of this age-group vs. 12.9% of 18-49y; p<0.01). Overall, PCV7 and PCV13 covered 25.6% and 63.7% of isolates, respectively, and 30.9% and 67.9% of isolates in mortality cases respectively.This nationwide active surveillance provides the baseline incidence, mortality rates and risk group distributions of IPD in adults before expected PCV effect.

Vaccines for preventing pneumococcal infection in adults

Diseases caused by Streptococcus pneumoniae (S. pneumoniae) continue to cause substantial morbidity and mortality globally. Whilst pneumococcal polysaccharide vaccines (PPVs) have the potential to prevent disease and death, the degree of protection afforded against various clinical endpoints and within different populations is uncertain. To assess the efficacy and effectiveness of PPVs in preventing pneumococcal disease or death in adults. We did not assess adverse events. We searched CENTRAL 2012, Issue 6, MEDLINE (January 1966 to June Week 2, 2012) and EMBASE (1974 to June 2012). We considered randomised controlled trials (RCTs) in adults, provided the study outcome met the definition of the outcome considered in the review. We also considered non-RCTs in adults, where the study assessed PPV effectiveness against culture-confirmed invasive pneumococcal disease (IPD), provided the study controlled for important confounding factors. Two review authors assessed trial quality of RCTs and three review authors extracted the data. We estimated odds ratios (ORs) and 95% confidence intervals (CIs) using a random-effects model. Two review authors assessed study quality and extracted data for non-RCTs. We calculated ORs and 95% CIs using a random-effects model following the conversion of each study outcome to a log OR and standard error (SE). Twenty-five studies met our inclusion criteria (18 RCTs involving 64,852 participants and seven non-RCTs involving 62,294 participants). Meta-analysis of the RCTs found strong evidence of PPV efficacy against IPD with no statistical heterogeneity (OR 0.26, 95% CI 0.14 to 0.45; random-effects model, I(2) statistic = 0%). There was efficacy against all-cause pneumonia in low-income (OR 0.54, 95% CI 0.43 to 0.67, I(2) statistic = 19%) but not high-income countries in either the general population (OR 0.71, 95% CI 0.45 to 1.12, I(2) statistic = 93%) or in adults with chronic illness (OR 0.93, 95% CI 0.73 to 1.19, I(2) statistic = 10%). PPV was not associated with substantial reductions in all-cause mortality (OR 0.90, 95% CI 0.74 to 1.09; random-effects model, I(2) statistic = 69%). Vaccine efficacy against primary outcomes appeared poorer in adults with chronic illness. Non-RCTs provided evidence for protection against IPD in populations for whom the vaccine is currently utilised (OR 0.48, 95% CI 0.37 to 0.61; random-effects model, I(2) statistic = 31%). This review did not consider adverse events as it was outside the scope of the review. This meta-analysis provides evidence supporting the recommendation for PPV to prevent IPD in adults. The evidence from RCTs is less clear with respect to adults with chronic illness. This might be because of lack of effect or lack of power in the studies. The meta-analysis does not provide evidence to support the routine use of PPV to prevent all-cause pneumonia or mortality.

Burden of pneumococcal infection in adults in Colombia

The burden of Streptococcus pneumoniae infections is highest in children. Estimates in adult population are uncommon. We determined the burden of disease associated with pneumococcus in adults in Colombia in year 2008. Using different data sources (official mortality records, medical databases, published literature and local epidemiological data) we estimated prevalence, incidence, mortality and disability due to bacterial pneumonia, bacterial meningitis and bacteremia of any cause for year 2008, and the fraction of these that can be attributed to S. pneumoniae. A total of 63,463 DALYs are lost due to S. pneumoniae in Colombians age 15 or over. Most of this burden (51,848 DALYs, 81.7%) is due to pneumonia, followed by meningitis (9241 DALYs, 14.6%). The three conditions, overall, represent 2.03 DALYs per 1000 Colombians in that age range. Despite the lower incidence of pneumococcal disease in adults, as compared with children, its burden is still significant, comparable to that of schizophrenia or epilepsy. This study may provide a benchmark for future preventive interventions.

PIN64 Burden of Pneumococcal Infection in Adults in Colombia

Streptococcus pneumoniae is responsible for more than a million deaths globally each year, most of them in the developing world. The burden of S. pneumoniae infections is highest in children. Estimates in adult population are uncommon. Our objective was to determine the burden of disease, measured in disability adjusted life years (DALYs), associated with pneumococcus in adults (older than 15 years of age) in Colombia in 2008. Using different data sources (national mortality records, official registries, published literature and local epidemiological data) we estimated incidence, mortality and disability due to bacterial pneumonia, bacterial meningitis and bacteremia of any cause for year 2008, and the fraction of these that can be attributed to S. pneumoniae. We used Murray's standard methodology to estimate DALYs (including age-weighting and discounting at 3%). There were 6488, 1276 and 452 deaths due to pneumonia, bacteremia and meningitis, respectively. Incidence rates for these same 3 diseases (before adjusting for underreporting, that has been estimated in 65%) were 233,814; 999 and 960, respectively. A total of 63,463 DALYs are lost due to S. pneumoniae in Colombians age 15 or over (55,362 DALYs, 87%, due to premature death). Most of the burden (51,848 DALYs, 81.7%) is due to pneumonia, followed by meningitis (9,241 DALYs, 14.6%). For the age group 65 and over, after adjusting for population, the burden increases 7 fold. The 3 conditions, overall, represent 2,03 DALYs per 1000 Colombians in that age range. Despite the lower incidence of pneumococcal disease in adults, as compared with children, its burden is still significant, comparable, for example, to that of schizophrenia or epilepsy in Colombia. This study may provide a benchmark for future preventive interventions and for efficient resource allocation.

The Incidence of Necrotizing Changes in Adults With Pneumococcal Pneumonia

Necrotizing pneumonia is generally considered a rare complication of pneumococcal infection in adults. We systematically studied the incidence of necrotizing changes in adult patients with pneumococcal pneumonia and examined the severity of infection, role of causative serotypes, and association with bacteremia. We used a database of all pneumococcal infections identified at our medical center between 2000 and 2010. Original readings of chest X-rays (CXR) and computerized tomography (CT) were noted. Images were then independently reevaluated by 2 radiologists. The severity of disease at admission was assessed using SMART-COP and Pneumonia Outcomes Research Team (PORT) scoring systems. In 351 cases of pneumococcal pneumonia, necrosis was reported in no (0%) original CXR readings and in 6 of 136 (4.4%) CTs. With rereading, 8 of 351 (2.3%) CXR and 15 of 136 (11.0%) CT had necrotizing changes. Overall, these changes were identified in 23 of 351 (6.6%) patients. The incidence of bacteremia and the admitting SMART-COP and PORT scores were similar in patients with and without necrosis (P = 1.00, P = .32, and P = .54, respectively). Type 3 pneumococcus was more commonly isolated from patients with necrosis than from patients without necrosis (P = .05), but 10 other serotypes were also implicated in 16 cases for which the organism was available for typing. Necrotizing changes in the lungs were seen in 6.6% of a large series of adults with pneumococcal pneumonia but were often overlooked on initial readings. Patients with necrosis were not more likely to have bacteremia or more severe disease. Type 3 pneumococcus was the most commonly identified serotype.