Epidemiology of invasive and non-invasive pneumococcal infections in hospitalised adult patients in a Lebanese medical centre, 2006-2015.

This is a retrospective medical file review of adult inpatients with Streptococcus pneumoniae infections admitted to a Lebanese hospital between 2006 and 2015. We revisited the clinical scenarios of these infections in view of increasing antibiotic resistance in Lebanon. One hundred and three patients were included; 92% were eligible for pneumococcal vaccination, yet none were vaccinated. Non-invasive pneumococcal disease (non-IPD) represented 64% of these infections. Superinfections caused by antibiotic-resistant bacteria were documented in 17.5% of the patients, with the predominance of ventilator-associated pneumonia (12.6%). Kidney disease and septic shock were positive predictors for mortality [adjusted odds ratio (OR) = 14.96, 95% confidence interval (CI) 2.34-95.45, P = 0.004; OR = 5.09, 95% CI 1.33-19.51, P = 0.02, respectively]. Herein, the differences in clinical success, S. pneumoniae infection-related death, and total mortality were not statistically significant between invasive pneumococcal disease (IPD) and non-IPD subgroups (59.5% vs. 77.3%, P = 0.056; 21.6% vs. 9.1%, P = 0.08; and 35.1% vs. 22.7%, P = 0.174; respectively). Upon comparing antibiotic susceptibility of S. pneumoniae during the first two years of the study (2006-2007) (n = 32 isolates) and the last two (2014-2015) (n = 14 isolates), there was an increasing non-susceptibility to penicillin (34.4%-50.0%, P = 0.25), and a decreasing susceptibility to erythromycin and clindamycin (81.3%-78.6%, P = 0.67 and 90.6%-85.7%, P = 0.65; respectively).

Epidemiology of pneumococcal infections in hospitalised adult patients in Lebanon with a highlight on non-invasive disease.

INTRODUCTION: Streptococcus pneumoniae causes a wide range of infections classified as invasive and non-invasive pneumococcal disease (non-IPD). METHODOLOGY: We retrospectively reviewed over a decade the clinical course and outcome of 103 adult subjects infected with S. pneumoniae. RESULTS: The majority of the subjects (92%) were eligible for pneumococcal vaccination, however none were vaccinated. Most of the infective strains caused non-IPD (64%), with CAP being the leading primary infection (49%). Clinical success was achieved in 71% of the cases and microbiological success in 94% of the cases with available documented follow-up cultures. Yet, 19% of the subjects developed superinfections caused by extensive-drug resistant bacteria with the predominance of ventilator-associated pneumonia (13%). Total in-hospital mortality reached 27% and S. pneumoniae infection attributed mortality was 20%. Using multivariate logistic regression, kidney disease and septic shock were independent risk factors for mortality [Odd's Ratio (OR) = 14.96 (2.34-95.45), p = 0.004; OR = 5.09 (1.33-19.51), p = 0.02, respectively]. On comparing outcome between subjects with IPD and those with non-IPD, death attributed to S. pneumoniae infection was found to be significantly higher in subjects with IPD (23%, p = 0.023). Nevertheless, clinical success and total in-hospital mortality rates were not statistically different between the two groups (p = 0.056, p = 0.174, respectively). CONCLUSION: S. pneumoniae remains a pathogen causing considerable mortality. In adults, non-IPD should be considered of comparable importance as IPD. Increasing pneumococcal vaccine awareness at the healthcare professional and patient levels is essential for increasing vaccine uptake, thus decreasing the incidence, severity and sequelea of pneumococcal disease.