Abstract
Serotypes 1, 3, 7F and 19A are implicated in childhood pneumococcal para-pneumonic effusion (PPE). It is not known whether the same is true for adult PPE.
A prospective cohort study was conducted over a two-year period. Consecutive adults admitted with community-acquired pneumonia (CAP) were studied. Pneumococcal serotype was identified from urine samples using a multiplex immunoassay.
Of 920 patients recruited, 366 patients had pneumococcal CAP; 100 of these had PPE with a serotype determined in 73. Factors associated with PPE were age, Pneumonia Severity Index and serotype. Serotypes most associated with PPE were 1 (n=18/40, 45%), 19A (n=9/20, 45%), and 3 (n=8/20, 40%). Serotypes common in childhood PPE were independently associated with adult PPE (adjusted odds ratio (OR) 2.3; p=0.003). Serotypes not included in the 7-valent conjugate vaccine were more likely to be associated with PPE (OR 2.1; p=0.024) compared to those in the vaccine. Serotypes included in PCV-13 were as likely to be associated with PPE as those that are not (OR 0.8; p=0.301).
Serotypes 1, 3, 7F and 19A are independently associated with adult PPE, a similar finding to childhood PPE. Serotype replacement following pneumococcal vaccine implementation may influence the spectrum of clinical disease.
- ERS