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Clinical and microbiological characteristics of unusual manifestations of invasive pneumococcal disease.

Abstract：

INTRODUCTION:Invasive pneumococcal disease (IPD) typically presents as bacterial pneumonia, meningitis or primary bacteraemia. However, Streptococcus pneumoniae can produce infection at any level of the body (endocarditis, arthritis, spontaneous bacterial peritonitis, etc.), which is also known as unusual IPD (uIPD). There are very limited data available about the clinical and microbiological profile of these uncommon manifestations of pneumococcal disease. Our aim was to analyse clinical forms, microbiological profile, epidemiology and prognosis of a cohort of patients with unusual invasive pneumococcal disease (uIPD). METHODS:We present a retrospective study of 389 patients (all adult and paediatric patients diagnosed during the period) diagnosed with IPD at our hospital (Complejo Hospitalario Universitario de Vigo) between 1992 and 2014. We performed an analysis of clinical, microbiological and demographical characteristics of patients comparing the pre-pneumococcal conjugate vaccine (PCV) period with the post-vaccination phase. IPD and uIPD were defined as follows; IPD: infection confirmed by the isolation of S. pneumoniae from a normally sterile site, which classically presented as bacterial pneumonia, meningitis or primary bacteraemia; uIPD: any case of IPD excluding pneumonia, meningitis, otitis media, rhinosinusitis or primary bacteraemia. RESULTS:A total of 22 patients (6%) met the criteria of uIPD. A Charlson index >2 was more prevalent in uIPD patients than IPD patients (45% vs 24%; p=0.08). The most common clinical presentation of uIPD was osteoarticular infection (8 patients, 36%), followed by gastrointestinal disease (4 patients, 18%). Infection with serotypes included in PCV-13 was significantly higher in IPD patients (65%) than in patients with uIPD, 35% (p=0.018). Conversely, infection with multidrug-resistant strains was higher among patient with uIPD (27% vs 9%; p=0.014). The all-cause mortality rate was 15%, 13% in the IPD group and 32% among patients with uIPD (p=0.07). According to the multivariate analysis, a Charlson Index >2 (OR 5.1, 95% CI, 1.8-14.0) and a Pitt Score >2 (OR 1.4, 95% CI, 1.2-1.9) were independent predictors of mortality. CONCLUSION:uIPD is a rare entity that affects patients with more comorbidities than typical IPD and it is usually caused by non-vaccine serotypes with greater antimicrobial resistance.

journal_name

Enferm Infecc Microbiol Clin

journal_title

Enfermedades infecciosas y microbiologia clinica

authors

Sousa A,Pérez-Rodríguez MT,Nodar A,Martínez-Lamas L,Vasallo FJ,Álvarez-Fernández M,Crespo M

doi

10.1016/j.eimc.2017.05.003

subject

Has Abstract

pub_date

2018-05-01 00:00:00

pages

284-289

issue

eissn

0213-005X

issn

1578-1852

pii

S0213-005X(17)30164-7

journal_volume

pub_type

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Clinical and microbiological characteristics of unusual manifestations of invasive pneumococcal disease.