Skip to main content

Advertisement

SpringerLink
Log in

Influence of chronic illnesses and underlying risk conditions on the incidence of pneumococcal pneumonia in older adults

  • Original Paper
  • Published:
Infection Aims and scope Submit manuscript

Abstract

Objective

To investigate hospitalizations from pneumococcal pneumonia in older adults with specific underlying chronic conditions, evaluating the influence of these conditions in developing pneumonia.

Methods

Population-based cohort study involving 27,204 individuals ≥60 years old in Southern Catalonia, Spain. All cases of hospitalization from pneumococcal pneumonia (bacteremic and nonbacteremic) were collected since 01/12/2008 until 30/11/2011. Cox regression was used to calculate hazards ratio (HR) and estimate the association between baseline conditions and the risk of developing pneumococcal pneumonia.

Results

Maximum incidences (per 1000 person-years) appeared among patients with history of prior pneumonia (14.6), nursing home residents (12.8), persons with immunodeficiency/asplenia (7.7) and patients with chronic pulmonary disease (7.6). In multivariable analysis, age (HR: 1.05), nursing home residence (HR: 4.59), history of prior pneumonia (HR: 3.58), stroke (HR: 2.50), chronic heart disease (HR: 1.53), chronic pulmonary disease (HR: 4.09), diabetes mellitus (HR: 1.66), smoking (HR: 1.69) and immunosuppressive medication (HR: 1.87) appeared significantly associated with an increased risk of pneumococcal pneumonia.

Conclusion

Our data support that nursing home residence, chronic pulmonary disease and immunocompromising conditions are the underlying conditions most strongly associated with an increasing risk of pneumococcal pneumonia in older adults. This data underline the need for better prevention strategies among these persons.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Lynch JP, Zhanel GG. Streptococcus pneumoniae: epidemiology and risk factors, evolution of antimicrobial resistance, and impact of vaccines. Curr Opin Pulm Med. 2010;16:217–25.

    PubMed  Google Scholar 

  2. Ortqvist A, Hedlund J, Kalin M. Streptococcus pneumoniae: epidemiology, risk factors, and clinical features. Semin Respir Crit Care Med. 2005;26:563–74.

    Article  PubMed  Google Scholar 

  3. van der Poll T, Opal SM. Pathogenesis, treatment, and prevention of pneumococcal pneumonia. Lancet. 2009;374:1543–56.

    Article  PubMed  Google Scholar 

  4. Naucler P, Darenberg J, Morfeldt E, Ortqvist A. Henriques Normark B. Contribution of host, bacterial factors and antibiotic treatment to mortality in adult patients with bacteraemic pneumococcal pneumonia. Thorax. 2013;68:571–9.

    Article  PubMed  Google Scholar 

  5. Fedson DS, Scott JA. The burden of pneumococcal disease among adults in developed and developing countries: what is and is not known. Vaccine. 1999;17:S11–8.

    Article  PubMed  Google Scholar 

  6. Centers for Disease Control and Prevention. Prevention of pneumococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 1997;46:1–24.

    Google Scholar 

  7. Pastor P, Medley F, Murphy TV. Invasive pneumococcal disease in Dallas County, Texas: results from population-based surveillance in 1995. Clin Infect Dis. 1998;26:590–5.

    Article  CAS  PubMed  Google Scholar 

  8. Harrison L, Dwyer D, Billmann L, Kolczak M, Schuchat A. Invasive pneumococcal infection in Baltimore, Maryland: implications for immunization policy. Arch Intern Med. 2000;160:89–94.

    Article  CAS  PubMed  Google Scholar 

  9. Kyaw MH, Rose CE Jr, Fry AM, Singleton JA, Moore Z, Zell ER, et al. The influence of chronic illnesses on the incidence of invasive pneumococcal disease in adults. J Infect Dis. 2005;192:377–86.

    Article  PubMed  Google Scholar 

  10. Atkinson W, Wolfe S, Hamborsky J, editors. Epidemiology and Prevention of Vaccine-Preventable Diseases. 12th ed. Washington: Public Health Foundation; 2011.

    Google Scholar 

  11. Said MA, Johnson HL, Nonyane BA, Deloria-Knoll M, O’Brien KL. AGEDD Adult Pneumococcal Burden Study Team. Estimating the burden of pneumococcal pneumonia among adults: a systematic review and meta-analysis of diagnostic techniques. PLoS One. 2013;8:e60273.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  12. Vila-Corcoles A, Hospital-Guardiola I, Ochoa-Gondar O, de Diego C, Salsench E, Raga X, et al. Rationale and design of the CAPAMIS study: effectiveness of pneumococcal vaccination against community-acquired pneumonia, acute myocardial infarction and stroke. BMC Public Health. 2010;10:25.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Ochoa-Gondar O, Vila-Corcoles A, Rodriguez-Blanco T, Gomez-Bertomeu F, Figuerola-Massana E, Raga-Luria X, Hospital-Guardiola I. Effectiveness of the 23-valent pneumococcal polysaccharide vaccine against community-acquired pneumonia in the general population aged ≥60 years: 3 years of follow-up in the CAPAMIS study. Clin Infect Dis. 2014;58:909–17.

    Article  CAS  PubMed  Google Scholar 

  14. METEOCAT. Servei meteorològic de Catalunya. Climatologia. Anuaris de dades meteorològiques. Available from URL: http://www.meteo.cat/servmet/index.html. Accessed Dec 17, 2013.

  15. Gutierrez F, Masia M, Rodríguez JC, Ayelo A, Soldán B, Cebrián L, et al. Evaluation of the immunochromatographic Binax NOW assay for detection of Streptococcus pneumoniae urinary antigen in a prospective study of community-acquired pneumonia in Spain. Clin Infect Dis. 2003;36:286–92.

    Article  CAS  PubMed  Google Scholar 

  16. Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44:S27–72.

    Article  CAS  PubMed  Google Scholar 

  17. Fine MJ, Smith MA, Carson CA, Mutha SS, Sankey SS, Weissfeld LA, et al. Prognosis and outcomes of patients with community-acquired pneumonia. A meta-analysis. JAMA. 1996;275:134–41.

    CAS  PubMed  Google Scholar 

  18. Hosmer DW, Lemeshow S. Applied survival analysis. Regression modeling of time to event data. New York: John Wiley; 1999. p. 159–80.

    Google Scholar 

  19. Feikin DR, Schuchat A, Kolczak M, Barrett NL, Harrison LH, Lefkowitz L, et al. Mortality from invasive pneumococcal pneumonia in the era of antibiotic resistance, 1995–1997. Am J Public Health. 2000;90:223–9.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  20. Klemets P, Lyytikäinen O, Ruutu P, Ollgren J, Nuorti J. Invasive pneumococcal infections among persons with and without underlying medical conditions: implications for prevention strategies. BMC Infect Dis. 2008;8:96.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Sicras-Mainar A, Ibáñez-Nolla J, Cifuentes I, Guijarro P, Navarro-Artieda R, Aguilar L. Retrospective epidemiological study for the characterization of community-acquired pneumonia and pneumococcal pneumonia in adults in a well-defined area of Badalona (Barcelona, Spain). BMC Infect Dis. 2012;12:283.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Kang CI, Song JH, Kim SH, Chung DR, Peck KR, Thamlikitkul V, et al. Risk factors and pathogenic significance of bacteremic pneumonia in adult patients with community-acquired pneumococcal pneumonia. J Infect. 2013;1:34–40.

    Article  Google Scholar 

  23. European Centre for Disease Prevention and Control. Annual Epidemiological Report 2011. Reporting on 2009 surveillance data and 2010 epidemic intelligence data. Stockholm: ECDC; 2011.

  24. Pilishvili T, Lexau C, Farley MM, Hadler J, Harrison LH, Bennett NM, et al. Sustained reductions in invasive pneumococcal disease in the era of conjugate vaccine. J Infect Dis. 2010;201:32–41.

    Article  PubMed  Google Scholar 

  25. Amber I, Gilbert E, Schiffman G, Jacobson J. Increased risk of pneumococcal infections in cardiac transplant recipients. Transplantation. 1990;49:122–5.

    Article  CAS  PubMed  Google Scholar 

  26. Dworkin MS, Ward JW, Hanson DL, Jones JL, Kaplan JE. Pneumococcal disease among human immunodeficiency virus-infected persons: incidence, risk factors, and impact of vaccination. Clin Infect Dis. 2001;32:794–800.

    Article  CAS  PubMed  Google Scholar 

  27. Nuorti JP, Butler JC, Farley MM, Harrison LH, McGeer A, Kolczak MS, et al. Cigarette smoking and invasive pneumococcal disease. N Engl J Med. 2000;342:681–9.

    Article  CAS  PubMed  Google Scholar 

  28. Robinson KA, Baughman W, Rothrock G, Barrett NL, Pass M, Lexau C, et al. Epidemiology of invasive Streptococcus pneumoniae infections in the United States, 1995–1998: opportunities for prevention in the conjugate vaccine era. JAMA. 2001;285:1729–35.

    Article  CAS  PubMed  Google Scholar 

  29. Schoenmakers MCJ, Hament JM, Fleer A, Aerts PC, van Dijk H, Kimpen JLL, Wolfs TFW. Risk factors for invasive pneumococcal disease. Rev Med Microbiol. 2002;13:29–36.

    Article  Google Scholar 

  30. Ardanuy C, Tubau F, Pallares R, Calatayud L, Domínguez MA, Rolo D, et al. Epidemiology of invasive pneumococcal disease among adult patients in Barcelona before and after pediatric 7-valent pneumococcal conjugate vaccine introduction, 1997–2007. Clin Infect Dis. 2009;48:57–64.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank the following persons for their contributions to data collection, analysis, laboratory work or manuscript preparation: Angels Vilanova and Josepa Tapiol (Hospital Joan XXIII), Xavier Cliville (Hospital Santa Tecla), Angel Vila-Rovira (Research Assistance on mortality data) and Timothy Bowring (assistance in the preparation of the manuscript). Funding for the study was provided, in part, by a grant from the “Fondo de Investigación Sanitaria” of the Instituto de Salud Carlos III, (09/00043). This study sponsor had no role in the design or implementation of the study, analysis of data, or reporting of the results.

Conflict of interest

The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. All the authors declare that they have not conflict of interest.

Author information

Authors and Affiliations

  1. Primary Care Service of Camp de Tarragona, Institut Catala de la Salut, Rambla Nova 124, D, 1ºA, 43001, Tarragona, Spain

    Angel Vila-Corcoles, Carlos Aguirre-Chavarria, Olga Ochoa-Gondar & Cinta de Diego

  2. Primary Care Research Institute (IDIAP Jordi Gol) and Research Associate, Autonomous University of Barcelona (UAB), Barcelona, Spain

    Teresa Rodriguez-Blanco

  3. Joan XXIII Hospital, Dr. Mallafrè Guasch, 4, 43005, Tarragona, Spain

    Frederic Gomez, Ramon Magarolas & Leonardo Esteban

  4. Santa Tecla Hospital, Rambla Vella, 14, 43003, Tarragona, Spain

    Xavier Raga & Luis Barnes

Authors
  1. Angel Vila-Corcoles
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carlos Aguirre-Chavarria
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Olga Ochoa-Gondar
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Cinta de Diego
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Teresa Rodriguez-Blanco
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Frederic Gomez
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Xavier Raga
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Luis Barnes
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ramon Magarolas
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Leonardo Esteban
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Olga Ochoa-Gondar.

Additional information

On behalf of EPIVAC Research Group.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vila-Corcoles, A., Aguirre-Chavarria, C., Ochoa-Gondar, O. et al. Influence of chronic illnesses and underlying risk conditions on the incidence of pneumococcal pneumonia in older adults. Infection 43, 699–706 (2015). https://doi.org/10.1007/s15010-015-0801-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s15010-015-0801-y

Keywords

Search

Navigation