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Carriage of streptococcus pneumoniae in adults hospitalised with community-acquired pneumonia
Rodrigo, Chamira Lim, Wei Shen
Rodrigo, Chamira
Lim, Wei Shen
Abstract
OBJECTIVES: We aimed to determine the prevalence of and risk factors for nasopharyngeal and oral pneumococcal carriage in adults with community-acquired pneumonia (CAP), and the relationship between carried and disease-causing serotypes., METHODS: Between 2016 and 2018, nasopharyngeal swabs, oral-fluid, and urine were collected from hospitalised adults recruited into a prospective cohort study of CAP. Pneumococcal carriage was detected by semi-quantitative real-time PCR of direct and culture-enriched nasopharyngeal swabs and culture-enriched oral-fluid. LytA and piaB positive/indeterminate samples underwent semi-quantitative serotype/serogroup-specific real-time-PCR. Serotypes in urine were identified using a 24-valent serotype-specific urinary-antigen assay., RESULTS: We included 465 CAP patients. Nasopharyngeal carriage was detected in 34/103 (33.0%) swabbed pneumococcal pneumonia patients and oral carriage in 18/155 (12%) of sampled pneumococcal pneumonia patients. Concordance between nasopharyngeal/urine serotypes and oral/urine serotypes was 70.6% and 50% respectively. Serotypes 3 (26%, 22.2%), 8 (19.7%, 19.4%), non-typeable (11.6%, 13.9%) and 19A/F (7.5%, 8.3%) were most prevalent in urine and nasopharyngeal swabs respectively, with non-typeable (35%) and 15A/F (17%) most prevalent in oral-fluid. Pneumococcal carriage was significantly associated with pneumococcal pneumonia (nasopharyngeal adjusted odds ratio aOR] 8.1, 95% confidence interval CI] 3.8-17.2; oral aOR 5.5, 95% CI 2.1-13.3). All-cause CAP patients >=65 years had lower odds of nasopharyngeal carriage (aOR 0.47, 95% CI 0.24-0.91) and current smokers had higher odds of oral carriage (aOR 2.69, 95% CI 1.10-6.60)., CONCLUSIONS: The association between nasopharyngeal carriage and pneumococcal CAP was strong. Adult carriage and disease from serotypes 8 and 19A may support direct protection of adults with PCV vaccines. Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.
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Date
2024
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Citation
Lansbury, L., McKeever, T.M., Lawrence, H., Pick, H., Baskaran, V., Edwards-Pritchard, R., Ashton, D., Rodrigo, C., Daniel, P., Litt, D., Eletu, S., Parmar, H., Sheppard, C.L., Ladhani, S., Trotter, C. and Lim, W.S. (2024) 'Carriage of streptococcus pneumoniae in adults hospitalised with community-acquired pneumonia', The Journal of Infection, 89(5), pp. 106277. doi: 10.1016/j.jinf.2024.106277 https://doi.org/10.1016/j.jinf.2024.106277.