Overview of pneumococcal serotypes and genotypes causing diseases in patients with chronic obstructive pulmonary disease in a Spanish hospital between 2013 and 2016

Abstract

BackgroundStreptococcus pneumoniae is an important pathogen in chronic obstructive pulmonary disease (COPD). We aimed at showing the recent changes in the epidemiology of pneumococcal diseases in patients with COPD, especially after the introduction of the 13-valent pneumococcal conjugate vaccine (PCV13).MethodsFrom 2013 to 2016, strains causing invasive pneumococcal disease (IPD), non-bacteremic pneumococcal pneumonia (non-BPP), and acute exacerbation of COPD (AE-COPD) were prospectively included. Antimicrobial susceptibility testing, serotyping, and genotyping were analyzed.ResultsWe collected 345 pneumococci from 286 COPD patients (57 IPD, 78 non-BPP, and 210 AE-COPD). The most frequent serotypes were serotypes 3 (14.0%), 8 (14.0%), and 12F (8.8%) in IPD; serotypes 3 (16.7%), 11A (9%), 9L/N (7.7%), and 23A (7.7%) in non-BPP; and serotypes 11A (11%), nontypeable (11%), and 6C (10%) in AE-COPD. Resistance rates were highest among AE-COPD strains. Penicillin resistance was associated with serotypes 11A (CC156) and 19A (CC320 and CC230). Compared with previous studies, fluoroquinolone resistance in AE-COPD increased (9.5%), PCV13 serotypes decreased (31.6%, 26.9%, and 16.7% for IPD, non-BPP, and AE-COPD, respectively), and serotype 11A-CC156 in AE-COPD and serotype 8 in IPD increased.ConclusionThe epidemiology of pneumococcal disease in COPD changed after the introduction of PCV13 in children. Increases in the highly invasive serotype 8 among patients with IPD and in serotype 11A-CC156 among patients with AE-COPD could compromise the ability of current PCVs to prevent diseases. Vaccines with a greater coverage could improve the benefits of adult vaccination.

Clinical Relevance and Molecular Pathogenesis of the Emerging Serotypes 22F and 33F of Streptococcus pneumoniae in Spain

“…in patients with COPD, serotypes 3 and 11A are among the most prevalent (Shoji et al, 2018). In addition, serotype 24F is more prone to cause meningitis, showing an increase in clinical severity (Balsells et al, 2018) which could be associated to the increase resistant pattern to phagocytosis when replicating as a biofilm.…”

Evolution, Clinical and Microbiological Characteristics of Invasive Pneumococcal Disease since the Introduction of the Pneumococcal Conjugate Vaccine 13-Valent in Adults over 18 Years Old

“…As for the severity and etiology of infections, no significant differences are shown between periods. Recent studies show the impact of PCV-13 on pneumococcal infection in patients with COPD, demonstrating an overall decrease in PCV-13 serotypes in that population [ 22 ]; this effect may not be remarkable in our series due to lack of sample size.…”

Two multi-fragment recombination events resulted in the β-lactam-resistant serotype 11A-ST6521 related to Spain9V-ST156 pneumococcal clone spreading in south-western Europe, 2008 to 2016

“…Possibly, this second recombination could be behind the higher capacity to form biofilms and to evade the host immune system of the recombinant 11A-ST6521 lineage which was previously described [10]. These traits can represent a patho-adaptive advantage of colonisation and also of causing biofilm-related diseases such as otitis media or acute exacerbations of COPD [9,10], possibly contributing to the resilience of PMEN3 lineages as a cause of pneumococcal disease in the PCV era.…”

“…This new lineage, related to Spain 9V -ST156, was penicillinand amoxicillin-resistant hampering the treatment of severe infections. Besides IPD, this amoxicillin-resistant variant of serotype 11A has in Spain caused acute exacerbations of COPD patients [9] and otitis media in children [39], infections for which amoxicillin usually is the first-choice antibiotic therapy.…”

“…Among them, an increase in serotype 11A, not included in PCV13, has been reported worldwide [1,4,6,7]. Many studies suggest that serotype 11A has a low invasive potential [5] being present mainly in child carriers [8] and patients with chronic obstructive pulmonary disease (COPD) [9]. Serotype 11A has classically been linked to the antibiotic-susceptible lineage CC62 [10], with the exception of some macrolide-resistant isolates with the M phenotype (resistance to 14-and 15-membered ring macrolides) [11].…”