Serotypes, risk factors, mortality and antibiotic susceptibility of Streptococcus pneumoniae isolated in meningeal infections in adults in ()

Méndez-Lage S. 1, Losada I. 2, Naveira G. 2, Agulla-Budiño JA. 1, Pardo-Sánchez F. 3, García-Garrote F. 4, Prieto-Rodríguez E. 5, Romero-Jung P. 6, Paz-Vidal I. 7, Martínez-Lamas L. 8, Vasallo-Vidal F. 8, Rodríguez-Conde I. 9, Alonso-Alonso P. 10, Rodríguez-Mayo M. 11,,Pulian-Morais, MV 12 , Hervada-Vidal, X. 2 1 CHUF, ; 2 Servicio de Epidemioloxía, de Compostela; 3 CHUS, Santiago de Compostela; 4 CHULA, ; 5 Hospital da Costa, Burela ; 6 Hospital Comarcal , Barco de Valdeorras; 7 CHOU, ; 8 CHUVI, ; 9 POVISA, Vigo; 10 Hospital Comarcal Monforte, Monforte de Lemos; 11 CHUAC, A Coruña; 12 CHOP, . INTRODUCTION/PURPOSE After introduction of pneumoccocal 13-valent conjugate vaccine (PCV13) in 2011, our objective was to determine the serotype distribution and antibiotic susceptibility of Streptococcus pneumoniae isolates causing meningitis in adults in Galicia (Spain), as well as associated risk factors and mortality.

MATERIALS AND METHODS S. pneumoniae isolates were collected from blood or CSF samples from patients with diagnosis of meningitis, from January 1st, 2011 to July 31st 2014, from all hospitals in Galicia. All isolates were serotyped by latex agglutination and Quellung reaction. Susceptibility was determined by broth microdilution and for penicillin and cefotaxime by E-test as well, following the CLSI criteria. Chronic respiratory, heart, liver and renal diseases, diabetes mellitus, asplenia, immunodeficiency no-HIV, HIV, smoking, alcoholism, previous pneumonia, hospital discharge <2 months and ENT diseases, were considered risk factors for pneumococcal disease. Comparisons were performed by Fisher's exact test and those variables showing statistical significance in the univariate analysis were included in a multivariate analysis with mortality as dependent variable.

RESULTS A total of 77 isolates were collected, 28.6% from blood and 71.4% from CSF. Age of patients was 63.33 +/- 15.81 years, with 58.44% males. We found 31 different serotypes: serotype 3 (10.39%), 6C (7.79%), 23B (6.49%), 19A (6.49%), 14 (5.19%), 7F (5.19%), 16F (5.19%) and other serotypes (53.25%), as represented in Figure 1. Related to vaccine, 36.36% belonged to serotypes included in the PCV13 and up to 44.15% in the PCV13 + 6C. Isolates belonging to PCV13 was 52.63% in the year 2011, 31.58% in 2012, 29.63% in 2013 and 33.33% in 2014 (Figure 2). Penicillin was found to be non-susceptible in 25.97% (CMI>0.06 µg/ml), being 20% serotype 14. 9.09% were non-susceptible to cefotaxime (CMI> 0.5 µg/ml), 57.14% serotype 14. All serotype 14 isolates were non-susceptible to penicillin and cefotaxime (Figure 3). Resistance to vancomycin was not found. Figure 2. Distribution of included/non-included in PCV13V and 6C serotypes, Figure 4. Risk factors in S. pneumoniae-associated meningal disease. Risk factors associated were: ENT diseases 41.6%, smoking 29.9%, immunodeficiency no-HIV each year and globally. 20.8%, liver pathology 18.2%, alcoholism 18.1%, diabetes mellitus 15.6%, chronic lung or heart disease 10.4%, hospital discharge <2 months 9.1%, renal disease 3.9%, HIV 3.9%, previous pneumonia 3.9% and asplenia 2.6%, as represented in Figure 4. Penicillin

Death rate was 20.8%. Risk factors associated to death rates were alcoholism and asplenia. In the 14 multivariate analysis death rate was linked to meningitis associated to ENT diseases. 19A CONCLUSIONS 11A 15A High serotype heterogeneity was found. 23B Only 36% of the isolates were included in the PCV13, and 6C 20% 44.15 % in PCV13 + 6C. 15C All serotype 14 isolates were not-susceptible to penicillin and 16A 19F cefotaxime. Global mortality was 20.8% and it was related to meningitis associated to ENT diseases.

Figure 3. Penicillin and cefotaxime-resistant serotypes Figure 1. Serotype distribution of meningeal disease-related S. pneumoniae strains isolated over a four-year period.