TB therapy and HIV tied to risk of MDR pneumococcal disease
HIV infection, tuberculosis (TB) treatment, age, and other factors raised the odds of multidrug-resistant (MDR) invasive pneumococcal disease (IPD) over a 5-year study period in South Africa before the pneumococcal vaccine era.
MDR Streptococcus pneumonia complicates disease
management and poses a particular threat to people with HIV.
Researchers in South Africa’s National Health Laboratory
Service and collaborators at other institutions conducted this
study to determine risk factors for MDR IPD and the potential
value of vaccination with the 13-valent pneumococcal conjugate
vaccine (PCV13) to reduce disease burden.
The investigators collected IPD data by lab-based surveillance
from 2003 through 2008. They defined multidrug resistance as
lack of bacterial susceptibility to three or more antibiotic
classes.
The research team identified 20,100 cases of IPD, or which
3708 (18%) had MDR isolates. Prevalence of MDR isolates rose
from 16% (461 of 2891) to 20% (648 of 3326) over the study
period (P < 0.001). Serotypes included in the
PCV13 vaccine accounted for 94% of MDR strains.
Multivariable logistic regression analysis identified the
following independent predictors of MDR IPD, at the following
odds ratios (OR) (and 95% confidence intervals):
• PCV13 serotypes (1486 of 6407): OR 6.3 (5.0 to
7.9)
• Pediatric serotypes (3382 of 9980): OR 12.8 (10.6
to 15.4)
• Age under 5 versus 15 to 64 (802 of 3110): OR 2.0
(1.8 to 2.3)
• Age 65 or older versus 15 to 64 (39 of 239): OR
1.5 (1.0 to 2.2)
• HIV infection (975 of 4636): OR 1.5 (1.2 to 1.8)
• Previous antibiotic use (242 of 803): OR 1.7 (1.4
to 2.1)
• Previous hospital admission (579 of 2450): OR 1.2
(1.03 to 1.4)
• Urban location (883 of 4375): OR 2.0 (1.1 to 3.5)
• TB treatment (246 of 1021): OR 1.2 (1.03 to 1.5)
“The effect of many of the MDR risk factors could be
reduced by more judicious use of antibiotics,” the
researchers propose.
“Because PCV13 serotypes account for most MDR
infections,” they observe, “pneumococcal
vaccination may reduce the prevalence of multidrug
resistance.”
Source: Penny Crowther-Gibson,
Cheryl Cohen, Keith P. Klugman, Linda de Gouveia, Anne von
Gottberg, for the Group for Enteric, Respiratory, and
Meningeal Disease Surveillance in South Africa (GERMS-SA).
Risk factors for multidrug-resistant invasive pneumococcal
disease in South Africa, a setting with high HIV prevalence,
in the prevaccine era from 2003 to 2008.
Antimicrobial Agents and Chemotherapy. 2012; 56:
5088-5095.
For the study abstract
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