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

  • Rima Moghnieh Makassed General Hospital, Beirut, Lebanon
  • Lyn Awad Pharmacy Department, Makassed General Hospital, Beirut, Lebanon
  • Dania Abdallah Pharmacy Department, Makassed General Hospital, Beirut, Lebanon
  • Rahil Sleiman Department of Internal Medicine, Makassed General Hospital, Beirut, Lebanon
  • Tamima Jisr Department of Laboratory Medicine, Makassed General Hospital, Beirut, Lebanon
  • Hani Tamim Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
  • Mona Al Helou Department of Obstetrics and Gynecology, Makassed General Hospital, Beirut, Lebanon
  • Ahmad Ibrahim Division of Hematology-Oncology, Department of Internal Medicine, Makassed General Hospital, Beirut, Lebanon
  • Anas Mugharbil Division of Hematology-Oncology, Department of Internal Medicine, Makassed General Hospital, Beirut, Lebanon
  • Nabila Droubi Pharmacy Department, Makassed General Hospital, Beirut, Lebanon
  • Lina Reslan Center for Infectious Diseases Research, American University of Beirut, Riad El-Solh, Beirut, Lebanon
  • Ghassan Matar Department of Experimental Pathology, Immunology, and Microbiology, American University of Beirut, Riad El-Solh, Beirut, Lebanon
  • Kamal Zahran Middle East Institute of Health, Bsalim, Lebanon
  • Ghassan Dbaibo Department of Pediatrics and Adolescent Medicine, Division of Pediatric Infectious Diseases, American University of Beirut, Riad El-Solh, Beirut, Lebanon
Keywords: bacteraemia, invasive pneumococcal disease, pneumonia, serotype, Streptococcus pneumoniae, vaccine

Abstract

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.

Published
2018-02-22
How to Cite
1.
Moghnieh R, Awad L, Abdallah D, Sleiman R, Jisr T, Tamim H, Al Helou M, Ibrahim A, Mugharbil A, Droubi N, Reslan L, Matar G, Zahran K, Dbaibo G (2018) Epidemiology of pneumococcal infections in hospitalised adult patients in Lebanon with a highlight on non-invasive disease. J Infect Dev Ctries 12:20S. doi: 10.3855/jidc.10106
Section
The Lebanese LSIDCM