title: Association of serotypes of Streptococcus pneumoniae with disease severity and outcome in adults: an international study.
abstract: BACKGROUND
  The introduction of conjugate pneumococcal vaccination for children has reduced the burden of invasive disease due to pneumococcal conjugate vaccine (PCV) types (i.e., serotypes 9V, 14, 6B, 18C, 23F, 19F, and 4) in adults. As nonvaccine serotypes become predominant causes of invasive disease among adults, it is necessary to evaluate the disease severity and mortality associated with infection due to nonvaccine serotypes, compared with PCV serotypes, in adults.
  
  
  METHODS
  The association of pneumococcal serotype and host-related variables with disease severity and mortality was statistically examined (with multivariable analysis) in 796 prospectively enrolled, hospitalized adult patients with bacteremia due to Streptococcus pneumoniae.
  
  
  RESULTS
  In multivariate analyses of risk in patients with invasive pneumococcal disease, older age (age, > or = 65 years; P = .004), underlying chronic disease (P = .025), immunosuppression (P = .035), and severity of disease (P < .001) were significantly associated with mortality; no association was found between nosocomial infection with invasive serotypes 1, 5, and 7 and mortality. The risk factors meningitis (P = .001), suppurative lung complications (P < or = .001), and preexisting lung disease (P = .051) were significantly associated with disease severity, independent of infecting serotype. No differences were seen in disease severity or associated mortality among patients infected with PCV serotypes, compared with patients infected with nonvaccine serotypes.
  
  
  CONCLUSIONS
  Our data support the notion that host factors are more important than isolate serotype in determining the severity and outcome of invasive pneumococcal disease and that these outcomes are unlikely to change in association with nonvaccine serotype infection in the post-conjugate vaccine era.
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
authors.forename: S R J
authors.initials: SR
authors.lastname: Alanee
authors.forename: L
authors.initials: L
authors.lastname: McGee
authors.forename: D
authors.initials: D
authors.lastname: Jackson
authors.forename: C C
authors.initials: CC
authors.lastname: Chiou
authors.forename: C
authors.initials: C
authors.lastname: Feldman
authors.forename: A J
authors.initials: AJ
authors.lastname: Morris
authors.forename: A
authors.initials: A
authors.lastname: Ortqvist
authors.forename: J
authors.initials: J
authors.lastname: Rello
authors.forename: C M
authors.initials: CM
authors.lastname: Luna
authors.forename: L M
authors.initials: LM
authors.lastname: Baddour
authors.forename: M
authors.initials: M
authors.lastname: Ip
authors.forename: V L
authors.initials: VL
authors.lastname: Yu
authors.forename: K P
authors.initials: KP
authors.lastname: Klugman
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D003428:Cross Infection; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011008:Pneumococcal Infections / Q000276:immunology / Q000401:mortality* / Q000503:physiopathology; D012307:Risk Factors; D012703:Serotyping; D012720:Severity of Illness Index; D013223:Statistics as Topic; D013296:Streptococcus pneumoniae / Q000145:classification* / Q000276:immunology