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Clinical features and outcomes of serotype 19A invasive pneumococcal disease in Calgary, Alberta

Leah J Ricketson¹, Otto G Vanderkooi², Melissa L Wood¹

¹Department of Pediatrics, University of Calgary, and Alberta Health Services - Calgary Zone, University of Calgary, Calgary, Alberta.

The Canadian Journal of Infectious Diseases & Medical Microbiology = Journal Canadien Des Maladies Infectieuses Et De La Microbiologie Medicale

|May 24, 2014

Insights

Streptococcus pneumoniae serotype 19A (ST19A) invasive pneumococcal disease (IPD) is more common in younger patients and associated with antibiotic resistance. ST19A IPD may require longer antibiotic treatment durations compared to other serotypes.

Area of Science:

Infectious Diseases
Epidemiology
Microbiology

Background:

The introduction of pneumococcal conjugate vaccines has shifted the landscape of invasive pneumococcal disease (IPD) epidemiology.
Streptococcus pneumoniae serotype 19A (ST19A) has emerged as a leading cause of IPD, particularly after vaccine introduction.
ST19A strains are frequently associated with multidrug resistance.

Purpose of the Study:

To compare the clinical course and outcomes of ST19A IPD with non-ST19A IPD.
To assess the impact of ST19A on treatment duration and intensive care unit (ICU) admission.

Main Methods:

Retrospective review of all IPD cases in Calgary, Alberta, from 2000 to 2010.
Utilized the Calgary Area Streptococcus pneumoniae Epidemiology Research (CASPER) study database.
Employed adjusted logistic and linear regression models to analyze outcomes.

Main Results:

ST19A IPD predominantly affected younger individuals.
A significantly higher proportion of ST19A isolates exhibited multidrug resistance (19% vs. 0.3%).
No significant difference in ICU admission rates was observed between ST19A and non-ST19A IPD cases.

Conclusions:

ST19A IPD is linked to a longer average duration of antibiotic therapy, even in susceptible strains.
ST19A infections may necessitate prolonged or higher-dose antibiotic treatment.
ST19A represents a significant challenge in IPD management due to its prevalence, resistance, and treatment implications.

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Abstract

Unlabelled:

The recent introduction of the seven-valent pneumococcal conjugate vaccine has led to changes in the proportion of disease caused by different serotypes. The serotypes targeted by the vaccine have been reduced, and Streptococcus pneumonia serotype 19A is now the most commonly isolated serotype causing invasive pneumococcal disease. This serotype has been associated with antibiotic resistance. The authors of this article conducted a review of cases of invasive pneumococcal disease diagnosed between 2000 and 2010 in Calgary, Alberta, to examine the disease course of serotype 19A invasive pneumococcal disease compared with other serotypes.

Background:

Streptoccocus pneumoniae serotype 19A (ST19A) became an important cause of invasive pneumococcal disease (IPD) after the introduction of the conjugate vaccine.

Objective:

To examine the severity and outcome of ST19A IPD compared with non-ST19A IPD.

Methods:

The Calgary Area Streptococcus pneumoniae Epidemiology Research (CASPER) study collects clinical and laboratory data on all IPD cases in Calgary, Alberta. Analysis was performed on data from 2000 to 2010 comparing ST19A and non-ST19A IPD cases. Adjusted linear and logistic regression models were used to examine outcomes of duration of appropriate intravenous antibiotic therapy and intensive care unit admission, respectively.

Results:

ST19A tended to cause disease in younger patients. ST19A isolates were more often multidrug resistant (19% versus 0.3%; P<0.001). Adjusted logistic regression showed no difference in intensive care unit admission between ST19A and non-ST19A IPD cases (OR 1.4 [95% CI 0.8 to 2.7]). An adjusted linear regression model showed patients <18 years of age with a diagnosis of bacteremia and no risk factors infected with ST19A were, on average, treated with antibiotics 1.4 times (95% CI 1.1 to 1.9) as long as patients with non-19A IPD and the same baseline characteristics.

Discussion:

ST19A IPD was associated with an increase in average time on antibiotics. Although many of the infecting strains of ST19A were within the threshold for susceptibility, they may be sufficiently resilient to require a longer duration of antibiotic therapy or higher dose to clear the infection.

Conclusions:

ST19A is more common in younger individuals, is more antibiotic resistant and may require longer average treatment duration.

Keywords:

Antibiotic resistance Meningitis Mortality Serotype 19A Streptococcus pneumoniae

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