International prevalence and risk factors evaluation for drug-resistant Streptococcus pneumoniae pneumonia - 19/09/19

Doi : 10.1016/j.jinf.2019.07.004

Stefano Aliberti ^a, Grayden S. Cook ^b, Bettina L. Babu ^b,^c, Luis F. Reyes ^d, Alejandro H. Rodriguez ^e, Francisco Sanz ^f, Nilam J. Soni ^b,^c, Antonio Anzueto ^b,^c, Paola Faverio ^g, Ricardo Franco Sadud ^h, Irfan Muhammad ⁱ, Cristina Prat ^j, Ester Vendrell ^k, Joao Neves ^l, Evangelos Kaimakamis ^m, Andrew Feneley ⁿ, Rajesh Swarnakar ^o, Fabio Franzetti ^p, Manuela Carugati ^p, Manuela Morosi ^p, Elisa Monge ^p, Marcos I. Restrepo ^b,^c,^⁎
GLIMP investigators^¹
See Appendix A: GLIMP investigators for GLIMP investigators.
^a Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, and University of Milan, Department of Pathophysiology and Transplantation, Milan Italy
^b Division of Pulmonary Diseases & Critical Care Medicine, The University of Texas Health Science Centre at San Antonio, San Antonio, TX, USA
^c Division of Pulmonary Diseases & Critical Care Medicine, South Texas Veterans Health Care System, 7400 Merton Minter Boulevard, San Antonio, TX 78229, USA
^d Department of microbiology, Universidad de la Sabana, Bogota, Colombia
^e Critical Care Medicine, Hospital Universitari Joan XXIII, Rovira & Virgili University and CIBERes (Biomedical Research Network of Respiratory disease), Tarragona, Spain
^f Pulmonology Department, Consorci Hospital General Universitari de Valencia, Valencia, Spain
^g Cardio-Thoracic-Vascular Department, University of Milan Bicocca, Respiratory Unit, San Gerardo Hospital, ASST di Monza, Monza, Italy
^h Section of Hospital Medicine, Medical College of Wisconsin, WI, USA
ⁱ Section of Pulmonary and Critical Care Medicine, Department of Medicine, Aga Khan University, Karachi-74800, Pakistan
^j Microbiology Department, Hospital Universitari Germans Trias i Pujol. Institut d'Investigació Germans Trias i Pujol, Badalona, Spain. Universitat Autònoma de Barcelona. CIBER Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Spain
^k Intensive Care Medicine, Hospital de Mataró, Spain
^l Serviço de Medicina, Centro Hospitalar do Porto, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal
^m Intensive Care Unit, “G. Papanikolaou” General Hospital of Thessaloniki, Greece
ⁿ University Hospitals of Leicester NHS Trust, Leicester, UK
^o Getwell Hospital & Research Institute, Dhantoli, Nagpur, India
^p Department of Biomedical and Clinical Sciences, Division of Infectious Diseases, Luigi Sacco Hospital, Università degli Studi di Milano, Milan, Italy

^⁎Corresponding author at: Division of Pulmonary Diseases & Critical Care Medicine, South Texas Veterans Health Care System, 7400 Merton Minter Boulevard, San Antonio, TX 78229, USA.Division of Pulmonary Diseases & Critical Care MedicineSouth Texas Veterans Health Care System7400 Merton Minter BoulevardSan AntonioTX78229USA

Highlights

•	Streptococcus pneumoniae was the most frequently identified pathogen in a cohort of patients with community acquired pneumonia (CAP) (268/3193 [8.3%]).
•	The global prevalence of drug resistant S. pneumoniae CAP (DRSP-CAP) was 1.3%.
•	Macrolide resistance was the most frequently identified in subjects with DRSP-CAP (0.6%) followed by penicillin resistance (0.5%).
•	The risk factors associated with specific antibiotic resistance were: asthma (for penicillin and macrolide), liver disease (for tetracycline resistance) and non-cystic fibrosis bronchiectasis (for penicillin resistance).

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Summary

Objective

Streptococcus pneumoniae is the most frequent bacterial pathogen isolated in subjects with Community-acquired pneumonia (CAP) worldwide. Limited data are available regarding the current global burden and risk factors associated with drug-resistant Streptococcus pneumoniae (DRSP) in CAP subjects. We assessed the multinational prevalence and risk factors for DRSP-CAP in a multinational point-prevalence study.

Design

The prevalence of DRSP-CAP was assessed by identification of DRSP in blood or respiratory samples among adults hospitalized with CAP in 54 countries. Prevalence and risk factors were compared among subjects that had microbiological testing and antibiotic susceptibility data. Multivariate logistic regressions were used to identify risk factors independently associated with DRSP-CAP.

Results

3,193 subjects were included in the study. The global prevalence of DRSP-CAP was 1.3% and continental prevalence rates were 7.0% in Africa, 1.2% in Asia, and 1.0% in South America, Europe, and North America, respectively. Macrolide resistance was most frequently identified in subjects with DRSP-CAP (0.6%) followed by penicillin resistance (0.5%). Subjects in Africa were more likely to have DRSP-CAP (OR: 7.6; 95%CI: 3.34-15.35, p<0.001) when compared to centres representing other continents.

Conclusions

This multinational point-prevalence study found a low global prevalence of DRSP-CAP that may impact guideline development and antimicrobial policies.

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Keywords : Pneumonia, Pneumococcal infection, Global burden of disease, Microbial drug resistant

Plan

Introduction

Study population and methods

Study design

Study subjects

Microbiological analysis

Data collection

Statistical analysis

Results

Streptococcus pneumoniae prevalence

Drug-resistant Streptococcus pneumoniae (DRSP)

Risk factors

Discussion

Conclusion

CRediT authorship contribution statement

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Vol 79 - N° 4

P. 300-311 - octobre 2019 Retour au numéro

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International prevalence and risk factors evaluation for drug-resistant Streptococcus pneumoniae pneumonia - 19/09/19

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