title: Some pneumococcal serotypes are more frequently associated with relapses of acute exacerbations in COPD patients.
abstract: OBJECTIVE
  To analyze the role of the capsular type in pneumococci causing relapse and reinfection episodes of acute exacerbation in COPD patients.
  
  
  METHODS
  A total of 79 patients with 116 recurrent episodes of acute exacerbations caused by S. pneumoniae were included into this study (1995-2010). A relapse episode was considered when two consecutive episodes were caused by the same strain (identical serotype and genotype); otherwise it was considered reinfection. Antimicrobial susceptibility testing (microdilution), serotyping (PCR, Quellung) and molecular typing (PFGE/MLST) were performed.
  
  
  RESULTS
  Among 116 recurrent episodes, 81 (69.8%) were reinfections, caused by the acquisition of a new pneumococcus, and 35 (30.2%) were relapses, caused by a pre-existing strain. Four serotypes (9V, 19F, 15A and 11A) caused the majority (60.0%) of relapses. When serotypes causing relapses and reinfection were compared, only two serotypes were associated with relapses: 9V (OR 8.0; 95% CI, 1.34-85.59) and 19F (OR 16.1; 95% CI, 1.84-767.20). Pneumococci isolated from relapses were more resistant to antimicrobials than those isolated from the reinfection episodes: penicillin (74.3% vs. 34.6%, p<0.001), ciprofloxacin (25.7% vs. 9.9%, p<0.027), levofloxacin (22.9% vs. 7.4%, p = 0.029), and co-trimoxazole (54.3% vs. 25.9%, p<0.001).
  
  
  CONCLUSIONS
  Although the acquisition of a new S. pneumoniae strain was the most frequent cause of recurrences, a third of the recurrent episodes were caused by a pre-existing strain. These relapse episodes were mainly caused by serotypes 9V and 19F, suggesting an important role for capsular type.
authors.affiliation: Department of Microbiology, Hospital Universitari de Bellvitge-IDIBELL-Barcelona University, Barcelona, Spain. c.ardanuy@bellvitgehospital.cat
authors.forename: Arnau
authors.initials: A
authors.lastname: Domenech
authors.forename: Carmen
authors.initials: C
authors.lastname: Ardanuy
authors.forename: Roman
authors.initials: R
authors.lastname: Pallares
authors.forename: Immaculada
authors.initials: I
authors.lastname: Grau
authors.forename: Salud
authors.initials: S
authors.lastname: Santos
authors.forename: Adela G
authors.initials: AG
authors.lastname: De la Campa
authors.forename: Josefina
authors.initials: J
authors.lastname: Liñares
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D058885:Multilocus Sequence Typing; D011008:Pneumococcal Infections / Q000150:complications* / Q000382:microbiology*; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications*; D012008:Recurrence; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000145:classification* / Q000187:drug effects / Q000235:genetics
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