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. 2019 Jul 31:13:1179548419862790.
doi: 10.1177/1179548419862790. eCollection 2019.

Streptococcus pneumoniae as a Cause of Community-Acquired Pneumonia in Indian Adolescents and Adults: A Systematic Review and Meta-Analysis

Canna J Ghia  1 , Raja Dhar  2 , Parvaiz A Koul  3 , Gautam Rambhad  1 , Mark A Fletcher  4
Affiliations

Streptococcus pneumoniae as a Cause of Community-Acquired Pneumonia in Indian Adolescents and Adults: A Systematic Review and Meta-Analysis

Canna J Ghia et al. Clin Med Insights Circ Respir Pulm Med. .

Abstract

Background: Streptococcus pneumoniae is one of the primary cause of community-acquired pneumonia (CAP) worldwide. However, scant data are available on the prevalence of etiological organisms for CAP in adolescent and adult Indian population.

Objective: We performed a systematic review and meta-analysis to determine the contribution of S. pneumoniae in the causation of CAP in Indian patients aged 12 years or above.

Methodology: We performed a systematic search of both indexed and non-indexed publications using PubMed, databases of National Institute of Science Communication and Information Resources (NISCAIR), Annotated Bibliography of Indian Medicine (ABIM), Google Scholar, and hand search including cross-references using key terms 'community acquired pneumonia AND India'. All studies, published between January 1990 and January 2017, that evaluated Indian patients aged above 12 years with a confirmed diagnosis of CAP were eligible for inclusion. Our search retrieved a total of 182 studies, of which only 17 and 12 qualified for inclusion in the systematic review of all etiological organisms, and meta-analysis of S. pneumonia, respectively.

Results: A total of 1435 patients met the inclusion criteria. The pooled proportion of patients with S. pneumoniae infection was 19% (95% confidence interval [CI]: 12%-26%; I2 = 94.5% where I2 represents heterogeneity, P < .01). Other major etiological agents are Mycoplasma pneumoniae (15.5% [1.1%-35.5%]), Klebsiella pneumoniae (10.5% [1.6%-24.0%]), and Legionella pneumophila (7.3% [2.5%-23.8%]).

Conclusions: Analysis found approximately a one-fifth proportion of adult Indian patients of CAP with S. pneumoniae infection, suggesting it as a leading organism for causing CAP compared with other etiological organisms.

Keywords: Community-acquired pneumonia; Streptococcus pneumoniae; aetiology; bacterial pneumonia; pneumonia.

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Conflict of interest statement

Declaration of conflicting interests:The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: CJG, GR, and MAF are employees of Pfizer, the manufacturer of pneumococcal conjugate vaccines. RD and PAK declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
PRISMA flow diagram. ABIM indicates Annotated Bibliography of Indian Medicine; NISCAIR, National Institute of Science Communication and Information Resources.
Figure 2.
Figure 2.
Forest plot displaying meta-analysis of proportion of Streptococcus pneumoniae infection in patients with community-acquired pneumonia. Binary random effects model was applied to get pooled proportion and 95% confidence interval (0.19; 95% CI 0.12–0.26; P < .01).
Figure 3.
Figure 3.
Prevalence range of etiological agents in community-acquired pneumonia in Indian setting. Blue and Grey dots are outliers; the cross (X) mark depicts the Mean.
See this image and copyright information in PMC

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