Identification of Streptococcus pneumoniae in hospital-acquired pneumonia in adults

Hospital-acquired pneumonia (HAP) is often more severe and life-threatening than community-acquired pneumonia (CAP). The role of Streptococcus pneumoniae in CAP is well-understood, but its role in HAP is unclear. The objective of this study was to summarize the available literature on the prevalence...

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Bibliographic Details
Published in:	The Journal of hospital infection Vol. 108; pp. 146 - 157
Main Authors:	Suaya, J.A., Fletcher, M.A., Georgalis, L., Arguedas, A.G., McLaughlin, J.M., Ferreira, G., Theilacker, C., Gessner, B.D., Verstraeten, T.
Format:	Journal Article
Language:	English
Published:	England Elsevier Ltd 01-02-2021
Subjects:	Intensive care unit Nosocomial Pneumococcal pneumonia Ventilator-associated pneumonia Ventilator-associated pneumonia Pneumococcal pneumonia Nosocomial Intensive care unit
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Summary:	Hospital-acquired pneumonia (HAP) is often more severe and life-threatening than community-acquired pneumonia (CAP). The role of Streptococcus pneumoniae in CAP is well-understood, but its role in HAP is unclear. The objective of this study was to summarize the available literature on the prevalence of S. pneumoniae in HAP episodes. We searched MEDLINE for peer-reviewed articles on the microbiology of HAP in individuals aged ≥18 years, published between 2008 and 2018. We calculated pooled estimates of the prevalence of S. pneumoniae in episodes of HAP using a random-effects, inverse-variance-weighted meta-analysis. Forty-seven of 1908 articles met the inclusion criteria. Bacterial specimen isolation techniques for microbiologically defined HAP episodes included bronchoalveolar lavage, protective specimen brush, tracheobronchial aspirate and sputum, as well as blood culture. Culture was performed in all studies; five studies also used urine antigen detection (5/47; 10.6%). S. pneumoniae was identified in 5.1% (95% confidence interval (CI): 3.8–6.6%) of microbiologically defined HAP episodes (N = 20), with 5.4% (95% CI: 4.3–6.7%, N = 29) in ventilator-associated HAP and 6.0% (95% CI: 4.1–8.8%, N = 6) in non-ventilator-associated HAP. S. pneumoniae was identified in 5.3% (95% CI: 4.5–6.3%) of HAP occurring in the intensive care unit (ICU, N = 41) and in 5.6% (95% CI: 3.3–9.5%, N = 5) outside the ICU. A higher proportion of early-onset HAP (10.3%; 95% CI: 8.3–12.8%, N = 16) identified S. pneumoniae as compared with late-onset HAP (3.3%; 95% CI: 2.5–4.4%, N = 16). In conclusion, S. pneumoniae was identified by culture in 5.1% of microbiologically defined HAP episodes. The importance of HAP as part of the disease burden caused by S. pneumoniae merits further research.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 ObjectType-Review-3 content type line 23
ISSN:	0195-6701 1532-2939
DOI:	10.1016/j.jhin.2020.09.036