Upper respiratory tract colonization with Streptococcus pneumoniae in adults

INTRODUCTION

Most of the current evidence regarding pneumococcal upper respiratory colonization in adults suggests that despite high disease burden, carriage prevalence is low. Contemporary studies on adult pneumococcal colonization have largely followed the pediatric approach by which samples are obtained mostly from the nasopharynx and bacterial detection is evaluated by routine culture alone. Recent evidence suggests that the 'pediatric approach' may be insufficient in adults and pneumococcal detection in this population may be improved by longitudinal studies that include samples from additional respiratory sites combined with more extensive laboratory testing.

AREAS COVERED

In this article, relevant literature published in peer review journals on adult pneumococcal colonization, epidemiology, detection methods, and recommendations were reviewed.

EXPERT OPINION

Respiratory carriage of Streptococcus pneumoniae has been underestimated in adults. Contemporary pneumococcal carriage studies in adults that collect samples from alternative respiratory sites such as the oropharynx, saliva, or nasal wash; are culture-enriched for pneumococcus; and use molecular diagnostic methods designed to target two pneumococcal DNA sequences should enhance pneumococcal detection in the adult respiratory tract. This finding may have implications for the interpretation of dynamics of pneumococcal transmission and vaccination.

1442. Pneumonia Hospitalizations Averted With 13-Valent Pneumococcal Conjugate Vaccination of Adults Aged 18–64 Years With Diabetes in the United States

Background

Methods

Results

Conclusion

Disclosures

1453. Ninety-One Day Quality of Life Post-Pneumonia Diagnosis in Adult Patients in Japan

Background

Pneumonia is a serious illness with potentially long-lasting but poorly-characterized impact on quality of life. The Japanese Goto Epidemiology Study is a prospective, active, population-based surveillance study of adults with community-onset pneumonia (COP), that includes assessment of Quality Adjusted Life Years (QALYs).

Methods

Patients with X-ray/CT scan confirmed COP enrolled in the Goto study and consented to participate in QALY assessment responded to Japanese versions of EuroQol-5D-5L (EQ-5D-5L) health state classification (primary), EQ-5D visual analog scale, and SF-6D (secondary) instruments. This interim analysis reports 91-day QALYs based on Day 1 (diagnosis), 8, 16, 31, and 91 EQ-5D-5L responses of patients enrolled between June 1, 2017 and February 7, 2008. For comparison, we developed hypothetical QALYs had the patients not developed pneumonia (control) using the EQ-5D-5L scores from Day -30 (via recall) carried forward and adjusted by the natural decline in scores and death with age. QALYs were calculated as the area (trapezoidal method) under the survival weighted pneumonia and control EQ-5D-5L QALY score curves.

Results

The 234 patients were 55% male, 88% aged ≥64 years, 45% nursing home residents, and 65% initially hospitalized (35% initially outpatient) for COP. Compliance for interviews among survivors was 100%. EQ-5D-5L scores were 0.732 at Day −30, decreased to 0.590 at diagnosis, and rose to 0.675 by Day 91. The average scores at all time points remained below Day −30 (all P values <0.01). Compared with hypothetical controls, development of pneumonia on average resulted in a loss of 0.0292 QALYs (P < 0.001) during the first 91 days of follow-up.

Conclusion

Among residents of Goto Island, Japan, significant QALY losses were observed in association with a diagnosis of pneumonia and had not returned to baseline by 3 months after diagnosis. Scores and cumulative QALY losses during the first 3 months after pneumonia diagnosis were comparable to those experienced by US adults with chronic heart failure during a 3-month period.

Disclosures

H. Glick,K. Hirano, Pfizer Inc.: Consultant, Research support. T. Miyazaki, Pfizer Inc.: Collaborator, Research support and Speaker honorarium. . J. Suaya, E. Gonzalez, B. D. Gessner, A. G. Arguedas, Pfizer Inc.: Employee and Shareholder, Salary. R. E. Isturiz, Pfizer, Inc: Employee and Shareholder, Salary and Stock & Stock Options. . S. Kohno, Pfizer Inc.: Consultant, Research support and Speaker honorarium.