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 - 22/09/20

Doi : 10.1016/j.jinf.2020.06.028

Emma L. Smith ^a,^{^{1
These two authors contributed equally.}}, India Wheeler ^a,^{^{1
These two authors contributed equally.}}, Hugh Adler ^a, Daniela M. Ferreira ^a, Raquel Sá-Leão ^b, Osman Abdullahi ^c, Ifedayo Adetifa ^d,^e,^f, Sylvia Becker-Dreps ^g, Susanna Esposito ^h, Helmia Farida ⁱ, Rama Kandasamy ^j,^k, Grant A. Mackenzie ^l,^m,^n,^o, J. Pekka Nuorti ^p,^q, Susan Nzenze ^r,^s, Shabir A. Madhi ^r,^s, Omar Ortega ^t,^u, Anna Roca ^l, Dodi Safari ^v, Frieder Schaumburg ^w, Effua Usuf ^l, Elisabeth A.M. Sanders ^x, Lindsay R. Grant ^y, Laura L. Hammitt ^y, Katherine L. O'Brien ^y, Prabhu Gounder ^z, Dana J.T. Bruden ^z, Michelle C. Stanton ^aa, Jamie Rylance ^a,^⁎
^a Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
^b Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa, Oeiras, Portugal
^c Department of Public Health, School of Health and Human Sciences, Pwani University, Kilifi, Kenya
^d Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
^e Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, United Kingdom
^f Department of Paediatrics and Child Health, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
^g Departments of Family Medicine and Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
^h Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
ⁱ Faculty of Medicine, Diponegoro University, Semarang, Indonesia
^j Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford OX3 7LE, United Kingdom
^k NIHR Oxford Biomedical Research Centre, Oxford OX3 7LE, United Kingdom
^l Medical Research Council The Gambia Unit at LSHTM, Banjul, The Gambia
^m Faculty of Infectious and Tropical Diseases, The London School of Hygiene & Tropical Medicine, United Kingdom
ⁿ Infection and Immunity Theme, Murdoch Children's Research Institute, Melbourne, Australia
^o Department of Paediatrics, University of Melbourne, Melbourne, Australia
^p Health Sciences Unit, Faculty of Social Sciences, Tampere University, Finland
^q Department of Health Security, National Institute for Health and Welfare (THL), Helsinki, Finland
^r Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa
^s Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
^t Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró, Universitat Autónoma de Barcelona, Mataró, Spain
^u Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain
^v Eijkman Institute for Molecular Biology, Jl. Diponegoro no. 69 Jakarta, Indonesia
^w Institute of Medical Microbiology, University Hospital Muenster, Muenster, Germany
^x Department of Pediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands
^y Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
^z Arctic Investigations Program, Division of Preparedness and Emerging Infections, Center for Disease Control and Prevention, Anchorage, Alaska
^aa Lancaster Medical School, Lancaster University, United Kingdom

^⁎Corresponding author.

Highlights

•	Systematic review and meta-analysis of 18 studies and more than 6000 participants.
•	Adults over the age of 60 had a pooled prevalence of pneumococcal carriage of 9%.
•	Risk factors: contact with children, smoking and residing in a nursing home.

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Summary

Background

Colonisation with Streptococcus pneumoniae can lead to invasive pneumococcal disease and pneumonia. Pneumococcal acquisition and prevalence of colonisation are high in children. In older adults, a population susceptible to pneumococcal disease, colonisation prevalence is reported to be lower, but studies are heterogeneous.

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.

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Keywords : Pneumococcal;  Colonisation;  Adults;  Risk factors

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Vol 81 - N° 4

P. 540-548 - octobre 2020 Retour au numéro

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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 - 22/09/20

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