PT  - JOURNAL ARTICLE
AU  - Thomas Bewick
AU  - Carmen Sheppard
AU  - Sonia Greenwood
AU  - Mary Slack
AU  - Caroline Trotter
AU  - Robert George
AU  - Wei Shen Lim
TI  - Serotypes associated with the development of pneumococcal para-pneumonic effusion in adults
AID  - 10.1183/09031936.00144712
DP  - 2013 Sep 01
TA  - European Respiratory Journal
PG  - 733--741
VI  - 42
IP  - 3
4099  - http://erj.ersjournals.com/content/42/3/733.short
4100  - http://erj.ersjournals.com/content/42/3/733.full
SO  - Eur Respir J2013 Sep 01; 42
AB  - 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 2-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 had pneumococcal CAP; 100 of these had PPE and a serotype was determined in 73 patients. Factors associated with PPE were age, pneumonia severity index score and serotype. Serotypes most associated with PPE were 1 (18 (45%) out of 40), 19A (9 (45%) out of 20) and 3 (8 (40%) out of 20). Serotypes common in childhood PPE were independently associated with adult PPE (adjusted OR 2.3; p = 0.003). Serotypes not included in the 7-valent pneumococcal conjugate vaccine (PCV) were more likely to be associated with PPE (OR 2.1; p = 0.024) compared with 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. Serotypes associated with pneumococcal para-pneumonic effusion in adults are similar to those in childhood disease http://ow.ly/l0nxw