The burden of PCV13 serotypes in hospitalized pneumococcal pneumonia in Spain using a novel urinary antigen detection test. CAPA study.

BACKGROUND: Streptococcus pneumoniae serotypes distribution in community-acquired pneumonia (CAP) requiring hospitalization in adults after introduction of PCV13 in children is not well known. Our aim was to evaluate the distribution of serotypes in pneumococcal pneumonia according to risk factors and comorbidity conditions after the introduction of PCV13 in children in 2010. METHODS: A prospective study from 2011 to 2014 was performed in immunocompetent adults hospitalized with CAP in 3 Spanish hospitals. Microbiological confirmation was obtained using a serotype specific urinary antigen detection test (UAD test), Binax Now and conventional cultures. RESULTS: 1258 adults were enrolled and pneumococcal pneumonia (invasive disease in 17.7%) was confirmed in 368 (29.3%) and 17.6% of the any-cause CAP were caused by PVC13 serotypes (3.5% PCV7 serotypes). Around 60% of pneumococcal CAP were caused by PCV13 serotypes (74.6% in invasive episodes vs 57.4% in non-invasive ones). The most prevalent serotypes in invasive disease were 1, 3, 7F, 19A and 14. No significant differences were observed in the distribution of PCV13 serotypes across the study periods. Regarding comorbidity, the rate of PCV13 serotypes was similar among them, and it was slightly higher in those with no underlying conditions. CONCLUSIONS: Serotypes included in PCV13 caused a significant proportion of CAP in adults with underlying conditions and in healthy adults, with no significant changes in cases due to PCV7 or PCV13 from 2011 to 2014, suggesting an insufficient indirect protection from childhood vaccination. Strategies for implementing pneumococcal vaccination of adults are encouraged to reduce the incidence of pneumococcal episodes.

Antigenuria positiva a neumococo y vacunación / Positive urine pneumococcal antigen test and vaccination

Introducción y objetivo: La detección del antígeno neumocócico en orina es una prueba útil pero puede presentar falsos positivos, entre ellos, la vacunación neumocócica. Material y métodos: Detección de las antigenurias positivas a neumococo en el Hospital de Denia (enero-febrero/2015). Se determinaron variables epidemiológicas, radiológicas, microbiológicas y antecedente de vacunación neumocócica (neumo-23 y/o neumo-13). Resultados: La antigenuria a neumococo mostró un resultado positivo en el 12,4% de 385 determinaciones. Solo en el 33,3% de los casos con antigenuria positiva se documentó infiltrado radiológico en la radiografía de tórax. En el 35,4% de los pacientes existía antecedente de vacunación neumocócica previa. En la mayor parte de los casos (87,5%) un antígeno neumocócico positivo supuso la prescripción de un tratamiento antibiótico. Conclusiones: La vacunación neumocócica puede generar falsos positivos a la antigenuria por neumococo en la práctica clínica, con la consiguiente prescripción innecesaria de antibióticos en gran número de casos (AU)

Introduction and objective: Although urine pneumococcal antigen is an useful test, it has false positives such as pneumococcal vaccination. Material and methods: Positive urine pneumococcal antigen in Hospital de Denia (January-February/2015). We studied epidemiological, radiological and microbiological variables as well as previous pneumococcal vaccination (neumo-23 and/or neumo-13). Results: Urine pneumococcal antigen test was positive in 12.4% of 385 cases. Only 33.3% of positive cases had pneumonia in chest X-ray, and 35.4% of patients had previous pneumococcal vaccination. In most cases (87.5%), an antibiotic was prescribed. Conclusions: Pneumococcal vaccination can produce a false positive result in the urine pneumococcal antigen test in clinical practice, leading to an unnecessary prescription of antibiotics (AU)