Multiple comorbidities increase the risk of death from invasive pneumococcal disease under the age of 65 years |
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| Institution: | 1. Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, Japan;2. Okinaka Memorial Institute for Medical Research, Japan;3. Department of Infectious Diseases, Keio University School of Medicine, Japan;4. Department of Microbiology, Tokyo Medical University, Japan;5. Department of Infectious Diseases, National Cancer Center Hospital, Japan;6. Center for General Medicine Education, Keio University School of Medicine, Japan;1. Department of Defense Medicine, National Defense Medical College, 3-2, Namiki, Tokorozawa, Saitama, Japan;2. Department of Dermatology, National Defense Medical College, 3-2, Namiki, Tokorozawa, Saitama, Japan;3. Division of Infectious Diseases and Pulmonary Medicine, Department of Internal Medicine, National Defense Medical College, 3-2, Namiki, Tokorozawa, Saitama, Japan;4. Research Institute for Physical Activity, Fukuoka University, 8-19-1 Nanakuma, Jonan-ku, Fukuoka, Japan;5. Department of Otolaryngology, Head and Neck Surgery, Self-Defense Forces Central Hospital, 1-2-24, Ikejiri, Setagaya, Tokyo, Japan;6. Department of General Medicine, Self-Defense Forces Central Hospital, 1-2-24, Ikejiri, Setagaya, Tokyo, Japan;7. Department of General Medicine, National Defense Medical College, 3-2, Namiki, Tokorozawa, Saitama, Japan;1. Division of Infection Control and Prevention, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan;2. Laboratory for Clinical Investigation, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan;3. Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan;1. Department of Orthopaedic Surgery, Aichi Children''s Health and Medical Center, 7-426 Morioka-cho, Obu, Aichi, 474-8710, Japan;2. Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan;3. Department of Comprehensive Pediatric Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan;1. Department of Bacteriology I, National Institute of Infectious Diseases, Tokyo, Japan;2. The Okinawa Society of Child Health, Okinawa, Japan;3. Nakamura Clinic Pediatric, Dermatology and Internal Medicine, Okinawa, Japan;4. Awase Daiichi Clinic, Okinawa, Japan;5. Syuri Child Clinic, Okinawa, Japan;6. Wanpaku Clinic, Okinawa, Japan;1. Department of Otorhinolaryngology-Head and Neck Surgery, Wakayama Medical University, Wakayama, Japan;2. Department of Pathology, University of Alabama at Birmingham, UK |
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| Abstract: | IntroductionRisk factors for death from invasive pneumococcal disease (IPD) have not been clearly established in patients aged under 65 years. We aimed to evaluate contributions of host and bacterial factors to the risk of death from IPD in patients aged under 65 years in Japan.MethodsIn this prospective, observational, multicenter cohort study, patients with IPD (n = 581) aged 6–64 years were enrolled between 2010 and 2017. We investigated the role of host and bacterial factors in 28-day mortality.ResultsThe mortality rate increased from 3.4% to 6.2% in patients aged 6–44 years to 15.5%–19.5% in those aged 45–64 years. Multivariable analysis identified the following risk factors for mortality: age 45–64 years (hazard ratio HR], 3.4; 95% confidence interval CI], 1.6–6.8, p = 0.001), bacteremia with unknown focus (HR, 2.0; 95% CI, 1.1–3.7, p = 0.024), meningitis (HR, 2.1; 95% CI, 1.1–4.0, p = 0.019), underlying multiple non-immunocompromising conditions (HR, 2.6; 95% CI, 1.1–7.4, p = 0.023), and immunocompromising conditions related to malignancy (HR, 2.4; 95% CI, 1.0–5.2, p = 0.039). Pneumococcal serotype was not associated with poor outcomes.ConclusionsHost factors, including age of 45–64 years and underlying multiple non-immunocompromising conditions, are important for the prognosis of IPD. Our results will contribute to the development of targeted pneumococcal vaccination strategies in Japan. |
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| Keywords: | Invasive pneumococcal disease Risk factor Underlying disease Outcome Pneumococcal conjugate vaccine Serotype IPD"} {"#name":"keyword" "$":{"id":"kwrd0045"} "$$":[{"#name":"text" "_":"invasive pneumococcal diseases IC"} {"#name":"keyword" "$":{"id":"kwrd0055"} "$$":[{"#name":"text" "_":"immunocompromising GOS"} {"#name":"keyword" "$":{"id":"kwrd0065"} "$$":[{"#name":"text" "_":"glasgow outcome scale PCV7"} {"#name":"keyword" "$":{"id":"kwrd0075"} "$$":[{"#name":"text" "_":"7-valent pneumococcal conjugate vaccine PCV13"} {"#name":"keyword" "$":{"id":"kwrd0085"} "$$":[{"#name":"text" "_":"13-valent pneumococcal vaccine PPSV23"} {"#name":"keyword" "$":{"id":"kwrd0095"} "$$":[{"#name":"text" "_":"23-valent pneumococcal polysaccharide vaccine NVT"} {"#name":"keyword" "$":{"id":"kwrd0105"} "$$":[{"#name":"text" "_":"non-vaccine type |
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