Serotypes in Adult Pneumococcal Pneumonia in Spain in the Era of Conjugate Vaccines

Abstract

We studied changes in serotype distribution and antimicrobial susceptibility in adult pneumococcal pneumonia in Spain (2011–2019). Among 895 pneumococci collected (433 bacteremic [BPP] and 462 non-bacteremic [non-BPP]), serotypes 3 (17%), 19A (10%), 8 (6.7%) and 11A (6.7%) were the most frequent. Serotypes 16F, 19A and 24F were associated with old people (≥65) and serotypes 4, 7F, 8, 12F and 19F to young adults. Serotypes 12F, 24F and 1 were significantly more frequent in BPP and serotypes 11A, 23A and 19F in non-BPP. Amoxicillin resistance was higher in non-BPP (17% vs. 11%) while penicillin non-susceptibility (37% vs. 24%) and macrolide resistance (29% vs. 14%) were higher in older adults. In the period 2017–2019, the vaccine coverages were: 32% (PCV13), 39% (PCV15), 65% (PCV20) and 69% (PPV23). Differences were found in serotype composition and antimicrobial resistance by age and type of infection. The maintenance of serotype 3 as a leading cause of adult pneumococcal pneumonia and the increase in highly invasive (serotype 8) or antimicrobial-resistant (serotype 11A) serotypes is worrisome. Further studies will be required to analyse the impact of the upcoming broader conjugate vaccines.

Ventilator-associated pneumonia is linked to a worse prognosis than community-acquired pneumonia in children

“…However, since 2016 the tax of pneumococcal invasive infection has decreased significantly, which is attributable to the systematic vaccination [ 42 ]. Currently, 97.9% of the target children for antinpneumococcal vaccine receive it, but only 68% of the adults older than 65 years uptake it [ 43 ].…”

Decalogue for the selection of oral antibiotics for lower respiratory tract infections

“…Table 1 shows the common susceptibility phenotypes in S. pneumoniae and H. influenzae, the associated resistance mechanism and the inferred prevalence of these phenotypes in Spain [36][37][38][39][40][41][42][43].…”

“…Resistance to macrolides would be close to 25%, with simultaneous resistance to both compounds estimated at around 12%. These isolates are increasing in some serotypes not included in the thirteen-valent pneumococcal conjugate vaccine [ 37 , 38 ]. Surveillance studies conducted in Spain have shown that among oral cephalosporins, cefditoren has a similar behaviour to intravenous third-generation cephalosporins, with higher rates of resistance to cefaclor, cefuroxime and cefixime [ 39 ].…”

Changes in pneumococcal serotypes distribution and penicillin resistance in healthy children five years after generalization of PCV10

“…However, the phenomenon of serotype replacement has occurred, whereby non-vaccine serotypes (NVSs) have expanded to fill the niche left vacant by VSs [ 12 ]. Typically, NVSs have low invasive potential [ [13] , [14] , [15] ], and the overall incidence of IPD has consistently been lower after the implementation of PCV [ 16 , 17 ]. In addition, serotype replacement remains an issue, as it may relatively negate the effectiveness of PCV due to the emergence of IPD related to NVSs [ 18 , 19 ].…”