Streptococcus pneumoniae (pneumococcus) remains a significant cause of both mild infections such as otitis media, sinusitis, and bronchitis and more severe manifestations such as bacteremia, pneumonia, and invasive pneumococcal disease. Several key serotypes have been targeted in vaccine development due to their association with increased infectivity. Pneumococcal vaccines are available in two formulations, the unconjugated purified polysaccharide (PPSV) and the conjugated formulation (PCV), which leads to a more robust and prolonged immune response. There have been dramatic reductions in mortality attributed to invasive pneumococcal disease over the past 2 decades due to improved vaccination rates and improved serotype coverage with the existing arsenal of vaccines (PCV13 and PPSV23). Utilizing both conjugate and purified polysaccharide modalities in series has produced greater and lasting immunity. The development of both the PCV15 and the PCV20 vaccines provides an opportunity to use conjugated vaccines against a wider spectrum of pneumococcal serotypes. National guidelines have been updated to incorporate the new pneumococcal vaccines into clinical practice. K E Y W O R D S conjugate vaccine, pneumococcal infections, polysaccharide vaccine, vaccination | 725 EL-BEYROUTY et al.adults 65 years of age or older. 5 The 2010 incidence of IPD for older adults and infants was markedly higher than that of individuals 18-34 years of age (≥65 years: 36.4 cases per 100,000, <1 year: 34.2 cases per 100,000, 18-34 years: 3.8 cases per 100,000). 5Incidence and severity of pneumococcal infection are also heavily impacted by host comorbidities. Underlying health conditions and certain lifestyle factors (Table 1) greatly increase risk. 1,6,7 Surveillance studies have shown that more than half of IPD cases in patients aged 18-64 years of age occurred in those with one or more comorbidities designated as ACIP indications for vaccination. The mortality rate within this group was also doubled when compared to individuals without underlying health conditions. 8 The incidence of pneumococcal infection for adults with hematologic malignancy or HIV is 20 times greater than that of unaffected adults. 1 Despite the importance of vaccinating adults with these comorbidities, individuals with immunocompromising conditions do not benefit as greatly from vaccination as those who are immunocompetent.Gender and race have been implicated in impacting the likelihood of pneumococcal infection as well. One analysis found that rates of IPD were 1.5-2 times higher in males than female patients. 9Black individuals, Native Alaskans, and Native Americans have been shown to be at an increased risk compared with white individuals. 10 Additionally, the incidence of pneumococcal infections is impacted by socioeconomic factors. Developing nations with nutritional deficiencies, lack of exclusive breastfeeding for the first 6 months of life, and lower air quality have higher rates of infection.

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Background The management of COVID-19 poses diagnostic challenges with regard to concomitant bacterial pneumonia. This may result in unnecessary antibiotic therapy. This analysis described the experience of an urban academic medical center’s management of non-ICU patients diagnosed with COVID-19 during the initial months of the pandemic and assessed the rate of concomitant bacterial pneumonia in this population. Methods This retrospective analysis evaluated patients 18 years and older admitted to Thomas Jefferson University Hospital (TJUH) between March 1, 2020 and July 31, 2020 who had a positive COVID-19 test, were symptomatic, and received at least one dose of antibiotics. Antibiotic therapy was considered appropriate if there was objective evidence of bacterial pneumonia. Per the TJUH COVID-19 guidelines, objective diagnostic criteria assessed included the following: MRSA nasopharyngeal swab, urine Legionella pneumophilia or Streptococcus pneumoniae antigen test, respiratory pathogen panel, and sputum culture. If patients did not have evidence of bacterial pneumonia, the threshold for appropriate discontinuation of antibiotics was 48 hours. Results 50 patients were included in the final analysis. Upon admission, 7 (14%) patients had clear chest radiographs, and 9 (25%) of the 36 patients with a procalcitonin drawn had a level ≥ 0.25, indicating a potential bacterial infection. 15 (30%) patients were known to be COVID-19 positive prior to being administered antibiotics. Additionally, 22 (44%) patients had an infectious diseases service consult during their admission. 25 (50%) patients were continued on antibiotics &gt; 48 hours. The mean duration of antibiotic therapy in the entire population was 3.4 days (82 hours). The monthly average duration of antibiotic therapy trended downward as the pandemic progressed. The most common empiric antibiotic regimen was ceftriaxone and azithromycin, received by 28 (56%) patients. Only 2 (4%) patients were diagnosed with bacterial pneumonia. Conclusion In a sample of 50 COVID patients the overall rate of concomitant bacterial pneumonia was 4%. Given this finding, it is vital to remain judicious with the use of antibiotics and to employ the assistance of antimicrobial stewardship colleagues when managing patients diagnosed with COVID-19. Disclosures Claudine El-Beyrouty, PharmD, BCPS, Astellas (Advisor or Review Panel member)Shionogi (Advisor or Review Panel member)