Epidemiology of invasive and non-invasive pneumococcal infections in hospitalised adult patients in a Lebanese medical centre, 2006–2015

Abstract

This is a retrospective medical file review of adult inpatients with Streptococcus pneumoniae infections admitted to a Lebanese hospital between 2006 and 2015. We revisited the clinical scenarios of these infections in view of increasing antibiotic resistance in Lebanon. One hundred and three patients were included; 92% were eligible for pneumococcal vaccination, yet none were vaccinated. Non-invasive pneumococcal disease (non-IPD) represented 64% of these infections. Superinfections caused by antibiotic-resistant bacteria were documented in 17.5% of the patients, with the predominance of ventilator-associated pneumonia (12.6%). Kidney disease and septic shock were positive predictors for mortality [adjusted odds ratio (OR) = 14.96, 95% confidence interval (CI) 2.34–95.45, P = 0.004; OR = 5.09, 95% CI 1.33–19.51, P = 0.02, respectively]. Herein, the differences in clinical success, S. pneumoniae infection-related death, and total mortality were not statistically significant between invasive pneumococcal disease (IPD) and non-IPD subgroups (59.5% vs. 77.3%, P = 0.056; 21.6% vs. 9.1%, P = 0.08; and 35.1% vs. 22.7%, P = 0.174; respectively). Upon comparing antibiotic susceptibility of S. pneumoniae during the first two years of the study (2006–2007) (n = 32 isolates) and the last two (2014–2015) (n = 14 isolates), there was an increasing non-susceptibility to penicillin (34.4%–50.0%, P = 0.25), and a decreasing susceptibility to erythromycin and clindamycin (81.3%–78.6%, P = 0.67 and 90.6%–85.7%, P = 0.65; respectively).

Keywords

• Invasive pneumococcal disease
• Non-invasive pneumococcal disease
• Serotype
• Streptococcus pneumoniae
• Lebanon