title: Pneumococcal empyema and complicated pneumonias: global trends in incidence, prevalence, and serotype epidemiology.
abstract: This review evaluates the serotype epidemiology of complicated pneumococcal pneumonia (CPP) during the period 1990-2012. PubMed and EMBASE were searched using the terms "empyema", "complicated pneumonia", "pleural infection", "necrotizing pneumonia", "pleural effusion", "parapneumonic effusion", "pneumatocele", or "lung abscess"; "pneumococcal" or "Streptococcus pneumoniae"; and "serotype" for studies on the epidemiology of complicated pneumonias published from January 1, 1990 to October 1, 2013. Studies with data on incidence and serotypes were included; reviews, case reports, and conference abstracts were excluded. Of 152 papers, 84 fitted the inclusion criteria. A few pneumococcal serotypes were predominant causes of CPP, particularly serotypes 1, 19A, 3, 14, and 7F. CPP was a more common manifestation of pneumococcal disease among older (>2 years old) than younger children. The data support increases in both reported incidence rates and proportions of CPP in children and adults during the period 1990-2012; specific increases varied by geographic region. The proportions of serotype 3 and, particularly in Asia, serotype 19A CPP have increased, whereas most studies show declines in serotype 14. Serotype 1 has been a predominant cause of CPP since 1990, while antibiotic resistance was infrequent among serotype 1 isolates. The reported incidence and proportions of CPP among pneumonia cases steadily increased from 1990 to 2012. Several factors might account for these increases, including enhanced disease detection due to a higher index of suspicion, more sophisticated diagnostic assays, and changes in the prevalence of serotypes with capacity to invade the pleural space that were not targeted by the 7-valent pneumococcal conjugate vaccine (PCV7).
authors.affiliation: Pfizer, Inc., 23-25, avenue du Dr Lannelongue, 75668, Paris Cedex 14, France, mark.a.fletcher@pfizer.com.
authors.forename: M A
authors.initials: MA
authors.lastname: Fletcher
authors.forename: H-J
authors.initials: HJ
authors.lastname: Schmitt
authors.forename: M
authors.initials: M
authors.lastname: Syrochkina
authors.forename: G
authors.initials: G
authors.lastname: Sylvester
mesh_terms: D004653:Empyema / Q000453:epidemiology*; D014943:Global Health; D006801:Humans; D015994:Incidence; D011018:Pneumonia, Pneumococcal / Q000150:complications* / Q000453:epidemiology*; D015995:Prevalence; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000145:classification / Q000302:isolation & purification*