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Pneumococcal infections in elderly patients attending hospital since PCV-13 authorization in Spain
Antoni Payeras1, Maria Peñaranda1, Antonio Iñigo2
1a Infectious Diseases Unit, Internal Medicine Department , Hospital Son Llàtzer , Palma de Mallorca , Spain.
Insights
Vaccination rates for pneumococcal infections in elderly patients were low post-PCV-13 authorization. Outcomes like mortality remained similar, though PCV-13 serotypes caused most infections, with a declining trend.
Area of Science:
- Infectious Diseases
- Vaccinology
- Geriatric Medicine
Background:
- Pneumococcal infections pose a significant threat to elderly individuals.
- The 13-valent pneumococcal conjugate vaccine (PCV-13) was introduced to reduce the burden of pneumococcal disease.
- Understanding post-vaccine trends in this demographic is crucial for public health strategies.
Purpose of the Study:
- To characterize pneumococcal infections in patients aged 65 and older following PCV-13 introduction in Spain.
- To evaluate clinical outcomes, serotype distribution, and antibiotic susceptibility in this population.
Main Methods:
- Retrospective study of pneumococcal pneumonia, empyema, and primary bacteremia cases in patients ≥65 years.
- Data collected from two hospitals in Majorca between 2010 and 2015.
- Analysis included clinical variables, causative serotypes, and antibiotic susceptibility.
Main Results:
- A total of 243 patients were included; 69.1% were male, with a median age of 76 years.
- Only 2.6% of patients had received pneumococcal vaccination.
- Bacteremia occurred in 61.9% of cases, associated with higher severity. Mortality (11.5%) was linked to complications at admission. Septic shock incidence increased post-PCV-13 authorization.
- PCV-13 serotypes accounted for 57.6% of infections, showing a decreasing trend over time, while antibiotic susceptibility remained stable.
Conclusions:
- Pneumococcal vaccination rates among elderly patients with infections remain very low.
- Despite the prevalence of PCV-13 serotypes, key outcomes like mortality did not worsen compared to the pre-PCV-13 era, except for an increase in septic shock.
- The findings highlight the need for improved vaccination uptake in the elderly population.
Objectives:
To study the characteristics and outcomes of pneumococcal infections in patients aged ≥65 years since the authorization of the 13-valent pneumococcal conjugate vaccine (PCV-13) in Spain.
Methods:
All pneumococcal pneumonias, empyemas or primary bacteraemias treated at two hospitals in Majorca from 2010 to 2015 were included. Clinical variables, serotypes, and antibiotic susceptibility were collected.
Results:
Two hundred and forty-nine pneumonias, 11 primary bacteraemias, and 2 empyemas in 243 patients were studied; 181 (69.1%) men, median age 76 years (range: 66-99). Seven (2.6%) were pneumococcal-vaccinated. Bacteraemia was present in 127 (61.9%) cases and related to a higher severity, p= 0.02, and not having chronic lung disease, p = 0.002. Ninety-seven (37%) episodes involved complications and 30 (11.5%) patients died. Mortality was related with the presence of complications at admission, p < 0.001. Only septic shock was more frequent in patients ≥65 years during the period 2010-2015 compared to the period 2006-2010: 38 of 262 (14.5%) vs. 17 of 212 (8%), p = 0.02. Most infections (57.6%) were due to PCV-13 serotypes but were not related to a worse prognosis. The proportion of PCV-13 serotypes tended to decrease from 61% (non-invasive) and 80% (invasive) in 2010-2011 to 33% and 47% in 2014-2015. The antibiotic susceptibility remained stable.
Conclusions:
Rates of pneumococcal vaccination in elderly patients with pneumococcal infections were very low. Except for septic shock, the main outcome variables (including mortality) were similar to the ones observed in the period preceding PCV-13 authorization. PCV-13 serotypes were responsible for most infections although they showed a decreasing trend.
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