Clinical and microbiological implications of invasive pneumococcal disease in hospitalized patients (1998-2013).
Infections caused by Streptococcus pneumoniae (pneumococcus) still represent a challenge for health systems around the world.



The objective of this study was to assess microbiological and clinical aspects in hospitalized patients with invasive pneumococcus disease between 1998 and 2013.



This was a retrospective study that analyzed the results of pneumococcus identification, serotyping, and susceptibility testing found in the Adolfo Lutz Institute databank. Personal variables, medical history and clinical outcome of patients admitted with invasive pneumococcal disease were analyzed. These were obtained from records of a public teaching hospital - Hospital das Clínicas Faculdade de Medicina Ribeirão Preto.



The sample comprised 332 patients. Patient age ranged from less than one month to 89 years old (mean 20.3 years) and the sample was predominately male. Pneumonia (67.8%) was the most common disease, accounting for 18.2% of deaths. Serotypes 14, 1, 3, 9V, 6B, 6A, 23F, 19A, 18C, 19F, 12F, and 4 were the most common (75.3%). Most patients, or 67.5%, were cured without any complication (success), 6.9% had some type of sequela (failure), and 25.6% died (failure). In the case of deaths due to meningitis, strains of fully penicillin resistant pneumococcus were isolated. Furthermore, 68.2% of patients who died presented some type of comorbidity. The 60 and older age group presented the most significant association (Odds Ratio=4.2), with outcome failure regardless of the presence of comorbidity. Serotype 18C was the most significant risk factor both in raw analysis (Odds Ratio=3.8) and when adjusted for comorbidity (Odds Ratio=5.0) or age (Odds Ratio=5.4). The same occurred with serotype 12F (respectively, Odds Ratio=5.1, Odds Ratio=5.0, and Odds Ratio=4.7) CONCLUSION: The present findings highlight the importance of IPD among young adults and older adults. In the era of conjugate vaccines, monitoring serotypes in different age groups is essential to assess the impact and adequacy of immunization.
Regional Laboratory Center VI, Instituto Adolfo Lutz, Ribeirão Preto, SP, Brazil. Electronic address: micmedeiros@ial.sp.gov.br.
Marta Inês Cazentini
MI
Medeiros
Hospital Center of Epidemiology, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil.
Bento Vidal de Moura
BV
Negrini
Hospital Center of Epidemiology, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil.
Jorgete Maria E
JM
Silva
Center of Bacteriology, Instituto Adolfo Lutz, São Paulo, SP, Brazil.
Samanta Cristine Grassi
SC
Almeida
Center of Bacteriology, Instituto Adolfo Lutz, São Paulo, SP, Brazil.
Maria Luiza
ML
Leopoldo
Maria Luiza
ML
Leopoldo Silva Guerra
Center of Bacteriology, Instituto Adolfo Lutz, São Paulo, SP, Brazil.
Silva
S
Guerra
Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo (USP), São Paulo, SP, Brazil.
Denise de
Dd
Andrade
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011008:Pneumococcal Infections / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D013296:Streptococcus pneumoniae / Q000145:classification / Q000302:isolation & purification*; D018074:Vaccines, Conjugate; D055815:Young Adult
D000900:Anti-Bacterial Agents; D018074:Vaccines, Conjugate
Comorbidity; Death; Serotypes; Streptococcus pneumoniae