Upper airways colonisation of Streptococcus pneumoniae in adults aged 60 years and older: A systematic review of prevalence and individual participant data meta-analysis of risk factors.

Autor: Smith EL; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom., Wheeler I; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom., Adler H; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom., Ferreira DM; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom., Sá-Leão R; Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa, Oeiras, Portugal., Abdullahi O; Department of Public Health, School of Health and Human Sciences, Pwani University, Kilifi, Kenya., Adetifa I; Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, United Kingdom; Department of Paediatrics and Child Health, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria., Becker-Dreps S; Departments of Family Medicine and Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States., Esposito S; Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy., Farida H; Faculty of Medicine, Diponegoro University, Semarang, Indonesia., Kandasamy R; Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford OX3 7LE, United Kingdom; NIHR Oxford Biomedical Research Centre, Oxford OX3 7LE, United Kingdom., Mackenzie GA; Medical Research Council The Gambia Unit at LSHTM, Banjul, The Gambia; Faculty of Infectious and Tropical Diseases, The London School of Hygiene & Tropical Medicine, United Kingdom; Infection and Immunity Theme, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia., Nuorti JP; Health Sciences Unit, Faculty of Social Sciences, Tampere University, Finland; Department of Health Security, National Institute for Health and Welfare (THL), Helsinki, Finland., Nzenze S; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa; Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa., Madhi SA; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa; Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa., Ortega O; Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró, Universitat Autónoma de Barcelona, Mataró, Spain; Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain., Roca A; Medical Research Council The Gambia Unit at LSHTM, Banjul, The Gambia., Safari D; Eijkman Institute for Molecular Biology, Jl. Diponegoro no. 69 Jakarta, Indonesia., Schaumburg F; Institute of Medical Microbiology, University Hospital Muenster, Muenster, Germany., Usuf E; Medical Research Council The Gambia Unit at LSHTM, Banjul, The Gambia., Sanders EAM; Department of Pediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands., Grant LR; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States., Hammitt LL; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States., O'Brien KL; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States., Gounder P; Arctic Investigations Program, Division of Preparedness and Emerging Infections, Center for Disease Control and Prevention, Anchorage, Alaska., Bruden DJT; Arctic Investigations Program, Division of Preparedness and Emerging Infections, Center for Disease Control and Prevention, Anchorage, Alaska., Stanton MC; Lancaster Medical School, Lancaster University, United Kingdom., Rylance J; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom. Electronic address: Jamie.Rylance@lstmed.ac.uk.
Jazyk: angličtina
Zdroj: The Journal of infection [J Infect] 2020 Oct; Vol. 81 (4), pp. 540-548. Date of Electronic Publication: 2020 Jun 17.
DOI: 10.1016/j.jinf.2020.06.028
Abstrakt: Background: Colonisation with Streptococcus pneumoniae can lead to invasive pneumococcal disease and pneumonia. Pneumococcal acquisition and prevalence of colonisation are high in children. In older adults, a population susceptible to pneumococcal disease, colonisation prevalence is reported to be lower, but studies are heterogeneous.
Methods: This is a systematic review and meta-analysis of prevalence of, and risk factors for, pneumococcal colonisation in adults ≥ 60 years of age (PROSPERO #42016036891). We identified peer-reviewed studies reporting the prevalence of S. pneumoniae colonisation using MEDLINE and EMBASE (until April 2016), excluding studies of acute disease. Participant-level data on risk factors were sought from each study.
Findings: Of 2202 studies screened, 29 were analysable: 18 provided participant-level data (representing 6290 participants). Prevalence of detected pneumococcal colonisation was 0-39% by conventional culture methods and 3-23% by molecular methods. In a multivariate analysis, colonisation was higher in persons from nursing facilities compared with the community (odds ratio (OR) 2•30, 95% CI 1•26-4•21 and OR 7•72, 95% CI 1•15-51•85, respectively), in those who were currently smoking (OR 1•69, 95% CI 1•12-2•53) or those who had regular contact with children (OR 1•93, 95%CI 1•27-2•93). Persons living in urban areas had significantly lower carriage prevalence (OR 0•43, 95%CI 0•27-0•70).
Interpretation: Overall prevalence of pneumococcal colonisation in older adults was higher than expected but varied by risk factors. Future studies should further explore risk factors for colonisation, to highlight targets for focussed intervention such as pneumococcal vaccination of high-risk groups.
Funding: No funding was required.
Competing Interests: Declaration of Competing Interest SBD reports research grants from Pfizer during the conduct of the study and personal fees from Pfizer outside of the submitted work. PG reports an investigator-initiated grant by Wyeth Pharmaceuticals (now Pfizer) on a pneumococcal colonisation study. The funding agency provided funding support only - they did not provide any input into the study design. SE reports grants and personal fees from GSK, personal fees from Merck, grants from Abbott, grants and personal fees from Sanofi Aventis, grants and personal fees from Vifor, grants from DMG, outside the submitted work. GM reports grants from Bill & Melinda Gates Foundation, grants from GAVI the Vaccine Alliance, grants from Pfizer Ltd, during the conduct of a pneumococcal colonisation study. EAMS reports grants from Wyeth, grants from Pfizer, during the conduct a pneumococcal study LLH reports grants from Pfizer, GSK, and Merck, outside the submitted work. LRG reports grants from Pfizer, GSK, and Merck, outside the submitted work and honorarium from Pfizer and Merck.
(Copyright © 2020. Published by Elsevier Ltd.)
Databáze: MEDLINE
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