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. 2018 Sep 4:11:1387-1400.
doi: 10.2147/IDR.S165093. eCollection 2018.

Overview of pneumococcal serotypes and genotypes causing diseases in patients with chronic obstructive pulmonary disease in a Spanish hospital between 2013 and 2016

Hisashi Shoji  1 , Daniel A Vázquez-Sánchez  1 , Aida Gonzalez-Diaz  1   2 , Meritxell Cubero  1   2 , Fe Tubau  1   2 , Salud Santos  2   3 , Dolores García-Somoza  1   2 , Josefina Liñares  1   2 , José Yuste  2   4 , Sara Martí  1   2 , Carmen Ardanuy  1   2
Affiliations

Overview of pneumococcal serotypes and genotypes causing diseases in patients with chronic obstructive pulmonary disease in a Spanish hospital between 2013 and 2016

Hisashi Shoji et al. Infect Drug Resist. .

Abstract

Background: Streptococcus pneumoniae is an important pathogen in chronic obstructive pulmonary disease (COPD). We aimed at showing the recent changes in the epidemiology of pneumococcal diseases in patients with COPD, especially after the introduction of the 13-valent pneumococcal conjugate vaccine (PCV13).

Methods: From 2013 to 2016, strains causing invasive pneumococcal disease (IPD), non-bacteremic pneumococcal pneumonia (non-BPP), and acute exacerbation of COPD (AE-COPD) were prospectively included. Antimicrobial susceptibility testing, serotyping, and genotyping were analyzed.

Results: We collected 345 pneumococci from 286 COPD patients (57 IPD, 78 non-BPP, and 210 AE-COPD). The most frequent serotypes were serotypes 3 (14.0%), 8 (14.0%), and 12F (8.8%) in IPD; serotypes 3 (16.7%), 11A (9%), 9L/N (7.7%), and 23A (7.7%) in non-BPP; and serotypes 11A (11%), nontypeable (11%), and 6C (10%) in AE-COPD. Resistance rates were highest among AE-COPD strains. Penicillin resistance was associated with serotypes 11A (CC156) and 19A (CC320 and CC230). Compared with previous studies, fluoroquinolone resistance in AE-COPD increased (9.5%), PCV13 serotypes decreased (31.6%, 26.9%, and 16.7% for IPD, non-BPP, and AE-COPD, respectively), and serotype 11A-CC156 in AE-COPD and serotype 8 in IPD increased.

Conclusion: The epidemiology of pneumococcal disease in COPD changed after the introduction of PCV13 in children. Increases in the highly invasive serotype 8 among patients with IPD and in serotype 11A-CC156 among patients with AE-COPD could compromise the ability of current PCVs to prevent diseases. Vaccines with a greater coverage could improve the benefits of adult vaccination.

Keywords: Streptococcus pneumoniae; chronic obstructive pulmonary disease; invasive pneumococcal disease; pneumococcal conjugate vaccine.

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Conflict of interest statement

Disclosure CA and JL received funding from Pfizer, unrelated to the present study. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flowchart representing the methodology used for the selection of Streptococcus pneumoniae isolates in patients with COPD. Abbreviation: COPD, chronic obstructive pulmonary disease.
Figure 2
Figure 2
Distribution of pneumococcal serotypes among IPD, non-BPP, and AE-COPD. Notes: Bars represent the proportion of each serotype among different disease types. Gray bars show IPD, white bars show non-BPP isolates, and black bars show AE-COPD isolates. Abbreviations: AE-COPD, acute exacerbation of chronic obstructive pulmonary disease; IPD, invasive pneumococcal disease; non-BPP, non-bacteremic pneumococcal pneumonia.
Figure 3
Figure 3
Distribution of pneumococcal serotypes by vaccine groups among AE-COPD isolates. Notes: Black bars show PCV7 serotypes, white bars show additional PCV13 serotypes, dark gray bars show additional PCV15 serotypes, and gray bars show non-PCV13 serotypes. Abbreviations: AE-COPD, acute exacerbation of chronic obstructive pulmonary disease; PCV7, 7-valent pneumococcal conjugate vaccine; PCV13, 13-valent pneumococcal conjugate vaccine; PCV15, 15-valent pneumococcal conjugate vaccine.
Figure 4
Figure 4
Main changes in the distribution of genotype–serotype combinations among AE-COPD. Notes: Bars showed the proportion of the different genotype–serotype combinations among AE-COPD pneumococci. Colors differentiate periods. Abbreviation: AE-COPD, acute exacerbation of chronic obstructive pulmonary disease.
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