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Microbiological and clinical characteristics of Streptococcus pneumoniae serotype 3 infection and risk factors for
Merve Arslan Aydin1, Rajendra Prasad Janapatla2, Chyi-Liang Chen2
1Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Background/Purpose:
Serotype 3 has persisted to be an important cause of invasive pneumococcal disease in adults in the post-vaccine era. We aimed to investigate clinical and microbiological characteristics of Streptococcus pneumoniae serotype 3 infection in Taiwan and identify the risk factors associated with severe clinical outcome.
Methods:
A multicenter observational study was conducted to analyze serotype 3 isolates collected between 2012 and 2021. Demographics, comorbidities, and risk categories were statistically compared with clinical outcome. Antimicrobial susceptibility testing and multilocus sequence typing were performed.
Results:
A total of 146 isolates were collected, including 12 isolates regarded as colonizers. Among 134 infected cases, 54 (40.3%) were aged 65 and older. Mortality was significantly associated with diabetes mellitus, immunosuppression, immunodeficiency, high-risk status, and older age. Susceptibility rates were high to levofloxacin (98.9%), moxifloxacin (100%), vancomycin (100%), and ceftriaxone (97.3%). 25.3% (37/146) of the isolates showed intermediate susceptibility and 0.7% (1/146) showed resistance to penicillin. ST180 was the dominant sequence type. ST13 and ST9625 isolates were less susceptible to penicillin and ceftriaxone.
Conclusions:
Serotype 3 infection showed a high mortality rate, especially in patients with older ages and comorbidities. Although the incidence rates decreased during the COVID-19 pandemic, serotype 3 remained as an important cause of infection after the implementation of PCV13. Developing a more effective vaccine against serotype 3 and monitoring the antimicrobial-resistant sequence types are necessary.
Insights
Streptococcus pneumoniae serotype 3 causes severe invasive pneumococcal disease in older adults and those with comorbidities. Monitoring antimicrobial resistance and developing new vaccines are crucial for managing this persistent pathogen.
Area of Science:
- Infectious Diseases
- Microbiology
- Epidemiology
Background:
- Serotype 3 Streptococcus pneumoniae remains a significant cause of invasive pneumococcal disease (IPD) in adults, even after the introduction of pneumococcal conjugate vaccine 13-valent (PCV13).
- Understanding the clinical and microbiological features of serotype 3 IPD is essential for effective management and prevention strategies.
Purpose of the Study:
- To investigate the clinical and microbiological characteristics of Streptococcus pneumoniae serotype 3 infections in Taiwan.
- To identify risk factors associated with severe clinical outcomes in patients with serotype 3 IPD.
- To assess antimicrobial susceptibility patterns and molecular epidemiology of serotype 3 isolates.
Main Methods:
- A multicenter observational study analyzed 146 Streptococcus pneumoniae serotype 3 isolates collected between 2012 and 2021.
- Demographic data, comorbidities, and clinical outcomes were compared.
- Antimicrobial susceptibility testing and multilocus sequence typing (MLST) were performed on the isolates.
Main Results:
- Of 134 infected cases, 40.3% were aged 65 or older. Mortality was significantly linked to diabetes mellitus, immunosuppression, immunodeficiency, high-risk status, and older age.
- High susceptibility rates were observed for levofloxacin (98.9%), moxifloxacin (100%), vancomycin (100%), and ceftriaxone (97.3%). Penicillin showed intermediate susceptibility in 25.3% and resistance in 0.7% of isolates.
- Sequence type (ST) 180 was dominant, while ST13 and ST9625 isolates exhibited reduced susceptibility to penicillin and ceftriaxone.
Conclusions:
- Serotype 3 Streptococcus pneumoniae infection is associated with high mortality, particularly in elderly patients with comorbidities.
- Despite a decrease during the COVID-19 pandemic, serotype 3 remains a key pathogen post-PCV13 implementation.
- Developing novel vaccines targeting serotype 3 and continuous surveillance of antimicrobial-resistant strains are imperative.
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