Trends in invasive and non-invasive Streptococcus pneumoniae disease in adults hospitalised in Bristol and Bath: a retrospective cohort study, 2006-2022
Challen, R.; Hyams, C.; Hettle, D.; Amin-Chowdhury, Z.; Grimes, C.; Ruffino, G.; Conway, R.; Heath, R.; North, P.; Malin, A.; Maskell, N. A.; Williams, P.; Williams, O. M.; Ladhani, S. N.; Danon, L.; Finn, A.
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ObjectivesPneumococcal surveillance typically focuses on invasive disease (IPD), collecting limited clinical data. We used a longitudinal adult cohort of IPD and non-invasive pneumococcal disease (non-IPD) patients in three hospitals between 2006-22, to describe clinical disease, including site of infection, and serotype distribution. MethodsThe demographics of IPD and non-IPD were compared and survival analysis performed. Features of IPD in different sites were compared and serotype distributions analysed using bootstrap resampling. ResultsOut of a total 3719 cases, non-IPD was responsible for 54.7%. IPD had a higher case-fatality ratio than non-IPD (14.8% versus 11.7%; P=0.005). Among the 1686 IPD cases, 15.3% were outside the respiratory tract. Those with meningitis were younger (54.9y vs LRTI 66.8y; P<0.001); and had high rates of ICU admission (63.4% vs LRTI 10.2%; P<0.001). We found a similar serotype distribution across different infection sites ConclusionsNon-IPD accounts for 54.7% (2033/3719) of total diagnosed cases in adults hospitalised during the PCV era. IPD manifests outside of the respiratory tract in 15.3% (258/1686). Higher valent PCVs will likely have a similar impact regardless of different clinical presentations.
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