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Meta-Analysis
. 2020 Oct;81(4):540-548.
doi: 10.1016/j.jinf.2020.06.028. Epub 2020 Jun 17.

Upper airways colonisation of Streptococcus pneumoniae in adults aged 60 years and older: A systematic review of prevalence and individual participant data meta-analysis of risk factors

Emma L Smith  1 , India Wheeler  1 , Hugh Adler  1 , Daniela M Ferreira  1 , Raquel Sá-Leão  2 , Osman Abdullahi  3 , Ifedayo Adetifa  4 , Sylvia Becker-Dreps  5 , Susanna Esposito  6 , Helmia Farida  7 , Rama Kandasamy  8 , Grant A Mackenzie  9 , J Pekka Nuorti  10 , Susan Nzenze  11 , Shabir A Madhi  11 , Omar Ortega  12 , Anna Roca  13 , Dodi Safari  14 , Frieder Schaumburg  15 , Effua Usuf  13 , Elisabeth A M Sanders  16 , Lindsay R Grant  17 , Laura L Hammitt  17 , Katherine L O'Brien  17 , Prabhu Gounder  18 , Dana J T Bruden  18 , Michelle C Stanton  19 , Jamie Rylance  20
Affiliations
Meta-Analysis

Upper airways colonisation of Streptococcus pneumoniae in adults aged 60 years and older: A systematic review of prevalence and individual participant data meta-analysis of risk factors

Emma L Smith et al. J Infect. 2020 Oct.

Abstract

Background: Colonisation with Streptococcus pneumoniae can lead to invasive pneumococcal disease and pneumonia. Pneumococcal acquisition and prevalence of colonisation are high in children. In older adults, a population susceptible to pneumococcal disease, colonisation prevalence is reported to be lower, but studies are heterogeneous.

Methods: This is a systematic review and meta-analysis of prevalence of, and risk factors for, pneumococcal colonisation in adults ≥ 60 years of age (PROSPERO #42016036891). We identified peer-reviewed studies reporting the prevalence of S. pneumoniae colonisation using MEDLINE and EMBASE (until April 2016), excluding studies of acute disease. Participant-level data on risk factors were sought from each study.

Findings: Of 2202 studies screened, 29 were analysable: 18 provided participant-level data (representing 6290 participants). Prevalence of detected pneumococcal colonisation was 0-39% by conventional culture methods and 3-23% by molecular methods. In a multivariate analysis, colonisation was higher in persons from nursing facilities compared with the community (odds ratio (OR) 2•30, 95% CI 1•26-4•21 and OR 7•72, 95% CI 1•15-51•85, respectively), in those who were currently smoking (OR 1•69, 95% CI 1•12-2•53) or those who had regular contact with children (OR 1•93, 95%CI 1•27-2•93). Persons living in urban areas had significantly lower carriage prevalence (OR 0•43, 95%CI 0•27-0•70).

Interpretation: Overall prevalence of pneumococcal colonisation in older adults was higher than expected but varied by risk factors. Future studies should further explore risk factors for colonisation, to highlight targets for focussed intervention such as pneumococcal vaccination of high-risk groups.

Funding: No funding was required.

Keywords: Pneumococcal;  Colonisation;  Adults;  Risk factors.

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Conflict of interest statement

Declaration of Competing Interest SBD reports research grants from Pfizer during the conduct of the study and personal fees from Pfizer outside of the submitted work. PG reports an investigator-initiated grant by Wyeth Pharmaceuticals (now Pfizer) on a pneumococcal colonisation study. The funding agency provided funding support only - they did not provide any input into the study design. SE reports grants and personal fees from GSK, personal fees from Merck, grants from Abbott, grants and personal fees from Sanofi Aventis, grants and personal fees from Vifor, grants from DMG, outside the submitted work. GM reports grants from Bill & Melinda Gates Foundation, grants from GAVI the Vaccine Alliance, grants from Pfizer Ltd, during the conduct of a pneumococcal colonisation study. EAMS reports grants from Wyeth, grants from Pfizer, during the conduct a pneumococcal study LLH reports grants from Pfizer, GSK, and Merck, outside the submitted work. LRG reports grants from Pfizer, GSK, and Merck, outside the submitted work and honorarium from Pfizer and Merck.

Figures

Fig. 1
Fig. 1
PRISMA flowchart describing the identification and inclusion of data sources.
Fig. 2
Fig. 2
Forest plot of pneumococcal colonisation rates by publication, grouped by country income category. ‘n’ indicates total participants contributing data. ‘data’ indicates participant level data (PLD), or agglomerated result from manuscript which includes adults of ages 60+ or 65+ (Study>60 and Study>65, respectively. ‘site’ indicates nasopharyngeal or oropharyngeal sampling (NP and OP respectively). Proportions colonised are given with exact binomial 95% confidence intervals for each study. Summary using a random effects logistic model with study as the random effect , , , , , , .
Fig. 3
Fig. 3
Each panel describes the colonisation rates for a given variable. Studies are indicated by dots which size describes the number of participants contributing data (see key). Lines connect data from the same study where these are available (where dots exist with no line, all participants who were colonised from that study fell into the given category). Graphs indicate studies with participant level data (green circles) and those with only summary data (purple triangles) PLD: Participant Level Data. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
See this image and copyright information in PMC

References

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