Upper airways colonisation of Streptococcus pneumoniae in adults aged 60 years and older: A systematic review of prevalence and individual participant data meta-analysis of risk factors

Abstract

Methods: This is a systematic review and meta-analysis of prevalence of, and risk factors for, pneumococcal colonisation in adults ≥ 60 years of age (PROSPERO #42016036891). We identified peer-reviewed studies reporting the prevalence of S. pneumoniae colonisation using MEDLINE and EMBASE (until April 2016), excluding studies of acute disease. Participant-level data on risk factors were sought from each study. Findings: Of 2202 studies screened, 29 were analysable: 18 provided participant-level data (representing 6290 participants). Prevalence of detected pneumococcal colonisation was 0-39% by conventional culture methods and 3-23% by molecular methods. In a multivariate analysis, colonisation was higher in persons from nursing facilities compared with the community (odds ratio (OR) 2 •30, 95% CI 1 •26-4 •21 and OR 7 •72, 95% CI 1 •15-51 •85, respectively), in those who were currently smoking (OR 1 •69, 95% CI 1 •12-2 •53) or those who had regular contact with children (OR 1 •93, 95%CI 1 •27-2 •93). Persons living in urban areas had significantly lower carriage prevalence (OR 0 •43, 95%CI 0 •27-0 •70). Interpretation: Overall prevalence of pneumococcal colonisation in older adults was higher than expected but varied by risk factors. Future studies should further explore risk factors for colonisation, to highlight targets for focussed intervention such as pneumococcal vaccination of high-risk groups. Funding: No funding was required.

A Comparative Profile of Oropharyngeal Colonization of Streptococcus pneumoniae and Hemophilus influenzae among HealthCare Workers (HCW) in a Tertiary Care Hospital and Non-HealthCare Individuals.

“…The rates of bacterial colonization mostly depend on the age, occupation, geographical area and socioeconomic conditions [ 13-16 ]. Current study shows that the people belonging to 56-70 years had more colonization of S.pneumoniae and H. influenzae when compared to people belonging to age groups between 18-55 years and this was concordant with few studies [ 17 ]. This could be due to decreasing immunity with increasing age and associated chronic conditions.…”

Experimental Human Pneumococcal Colonization in Older Adults Is Feasible and Safe, Not Immunogenic

“…We hypothesised that the older population was somehow less susceptible to pneumococcal colonisation than younger adults, a hypothesis that we now reject based on our experimental colonisation data. After our study was completed, we collaborated on a meta-analysis that combined studies conducted in over-60s with participant-level data on over-60s from colonisation studies of the general population (33). This meta-analysis found widely variable point-prevalence rates (0-39%), but an overall rate of 9% (95% CI 6-14%).…”

A Murine Model for Enhancement ofStreptococcus pneumoniaePathogenicity Upon Viral Infection and Advanced Age

“…The rate of reported colonization is quite variable among adults and is confounded by differences in detection methods, but colonization may be more prevalent in the elderly (10). A meta-analysis of twenty nine published studies found that in individuals above 60 years of age, conventional culture showed 0-39% carriage, while 3-23% carriage was detected by molecular methods (11). Importantly, carriage was higher among nursing home residents (11).…”

“…A meta-analysis of twenty nine published studies found that in individuals above 60 years of age, conventional culture showed 0-39% carriage, while 3-23% carriage was detected by molecular methods (11). Importantly, carriage was higher among nursing home residents (11). In older adults, conventional culture methods estimated carriage to be <5% (12–14) but more recent data from European studies using molecular detection methods indicated that carriage in the elderly ranges from 10-22% (10, 15–17).…”