Pneumococcal infections in elderly patients attending hospital since PCV-13 authorization in Spain.
OBJECTIVE
To study the characteristics and outcomes of pneumococcal infections in patients aged ≥65 years since the authorization of the 13-valent pneumococcal conjugate vaccine (PCV-13) in Spain.


METHODS
All pneumococcal pneumonias, empyemas or primary bacteraemias treated at two hospitals in Majorca from 2010 to 2015 were included. Clinical variables, serotypes, and antibiotic susceptibility were collected.


RESULTS
Two hundred and forty-nine pneumonias, 11 primary bacteraemias, and 2 empyemas in 243 patients were studied; 181 (69.1%) men, median age 76 years (range: 66-99). Seven (2.6%) were pneumococcal-vaccinated. Bacteraemia was present in 127 (61.9%) cases and related to a higher severity, p= 0.02, and not having chronic lung disease, p = 0.002. Ninety-seven (37%) episodes involved complications and 30 (11.5%) patients died. Mortality was related with the presence of complications at admission, p < 0.001. Only septic shock was more frequent in patients ≥65 years during the period 2010-2015 compared to the period 2006-2010: 38 of 262 (14.5%) vs. 17 of 212 (8%), p = 0.02. Most infections (57.6%) were due to PCV-13 serotypes but were not related to a worse prognosis. The proportion of PCV-13 serotypes tended to decrease from 61% (non-invasive) and 80% (invasive) in 2010-2011 to 33% and 47% in 2014-2015. The antibiotic susceptibility remained stable.


CONCLUSIONS
Rates of pneumococcal vaccination in elderly patients with pneumococcal infections were very low. Except for septic shock, the main outcome variables (including mortality) were similar to the ones observed in the period preceding PCV-13 authorization. PCV-13 serotypes were responsible for most infections although they showed a decreasing trend.
a Infectious Diseases Unit, Internal Medicine Department , Hospital Son Llàtzer , Palma de Mallorca , Spain.
Antoni
A
Payeras
a Infectious Diseases Unit, Internal Medicine Department , Hospital Son Llàtzer , Palma de Mallorca , Spain.
Maria
M
Peñaranda
b Microbiology Department , Hospital Son Espases , Palma de Mallorca , Spain.
Antonio
A
Iñigo
b Microbiology Department , Hospital Son Espases , Palma de Mallorca , Spain.
Margarita
M
Garau
b Microbiology Department , Hospital Son Espases , Palma de Mallorca , Spain.
José
J
Luis Pérez
b Microbiology Department , Hospital Son Espases , Palma de Mallorca , Spain.
Carmen
C
Gallegos
a Infectious Diseases Unit, Internal Medicine Department , Hospital Son Llàtzer , Palma de Mallorca , Spain.
Melchor
M
Riera
D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D004653:Empyema / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008499:Medical Records; D011008:Pneumococcal Infections / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D022242:Pneumococcal Vaccines; D011018:Pneumonia, Pneumococcal / Q000150:complications / Q000453:epidemiology* / Q000517:prevention & control / Q000821:virology; D011446:Prospective Studies; D065288:Serogroup; D012772:Shock, Septic / Q000453:epidemiology / Q000209:etiology; D013030:Spain / Q000453:epidemiology; D013296:Streptococcus pneumoniae / Q000145:classification / Q000276:immunology / Q000302:isolation & purification; D014611:Vaccination / Q000706:statistics & numerical data*
C538862:13-valent pneumococcal vaccine; D022242:Pneumococcal Vaccines
Pneumococcal pneumonia; clinical features; invasive pneumococcal disease; outcome; pneumococcal conjugate vaccines