title: Serotypes associated with the development of pneumococcal para-pneumonic effusion in adults.
abstract: Serotypes 1, 3, 7F and 19A are implicated in childhood pneumococcal para-pneumonic effusion (PPE). It is not known whether the same is true for adult PPE. A prospective cohort study was conducted over a 2-year period. Consecutive adults admitted with community-acquired pneumonia (CAP) were studied. Pneumococcal serotype was identified from urine samples using a multiplex immunoassay. Of 920 patients recruited, 366 had pneumococcal CAP; 100 of these had PPE and a serotype was determined in 73 patients. Factors associated with PPE were age, pneumonia severity index score and serotype. Serotypes most associated with PPE were 1 (18 (45%) out of 40), 19A (9 (45%) out of 20) and 3 (8 (40%) out of 20). Serotypes common in childhood PPE were independently associated with adult PPE (adjusted OR 2.3; p = 0.003). Serotypes not included in the 7-valent pneumococcal conjugate vaccine (PCV) were more likely to be associated with PPE (OR 2.1; p = 0.024) compared with those in the vaccine. Serotypes included in PCV-13 were as likely to be associated with PPE as those that are not (OR 0.8; p = 0.301). Serotypes 1, 3, 7F and 19A are independently associated with adult PPE, a similar finding to childhood PPE. Serotype replacement following pneumococcal vaccine implementation may influence the spectrum of clinical disease.
authors.affiliation: Dept of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: Thomas
authors.initials: T
authors.lastname: Bewick
authors.forename: Carmen
authors.initials: C
authors.lastname: Sheppard
authors.forename: Sonia
authors.initials: S
authors.lastname: Greenwood
authors.forename: Mary
authors.initials: M
authors.lastname: Slack
authors.forename: Caroline
authors.initials: C
authors.lastname: Trotter
authors.forename: Robert
authors.initials: R
authors.lastname: George
authors.forename: Wei Shen
authors.initials: WS
authors.lastname: Lim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000382:microbiology*; D005260:Female; D006801:Humans; D007118:Immunoassay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010996:Pleural Effusion / Q000382:microbiology*; D011018:Pneumonia, Pneumococcal / Q000382:microbiology*; D011446:Prospective Studies; D012307:Risk Factors; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000145:classification*