Invasive pneumococcal disease in healthy adults: increase of empyema associated with the clonal-type

Background: Adult invasive pneumococcal disease (IPD) occurs mainly in the elderly and patients with co-morbidities. Little is known about the clinical characteristics, serotypes and genotypes causing IPD in healthy adults. Methods: We studied 745 culture-proven cases of IPD in adult patients aged 18–64 years (1996–2010). Patients were included in two groups: 1.) adults with co-morbidities, and 2.) healthy adults, who had no prior or coincident diagnosis of a chronic or immunosuppressive underlying disease. Microbiological studies included pneumococcal serotyping and genotyping. Results: Of 745 IPD episodes, 525 (70%) occurred in patients with co-morbidities and 220 (30%) in healthy adults. The healthy adults with IPD were often smokers (56%) or alcohol abusers (18%). As compared to patients with co-morbidities, the healthy adults had (P,0.05): younger age (43.5+/213.1 vs. 48.7+/211.3 years); higher proportions of women (45 % vs. 24%), pneumonia with empyema (15 % vs. 7%) and infection with non-PCV7 serotypes including serotypes 1 (25 % vs. 5%), 7F (13 % vs. 4%), and 5 (7 % vs. 2%); and lower mortality (5 % vs. 20%). Empyema was more frequently caused by serotype 1. No death occurred among 79 patients with serotype 1 IPD. There was an emergence of virulent clonal-types Sweden1-ST306 and Netherlands7F-ST191. The vaccine serotype coverage with the PCV13 was higher in healthy adults than in patients with co-morbidities: 82 % and 56%, respectively, P,0.001