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Abstract
Objectives To characterise the pattern of colonisation and serotypes of Streptococcus pneumoniae among patients with chronic obstructive pulmonary disease (COPD) who currently receive the 23-valent pneumococcal polysaccharide vaccine (PPV-23) according to vaccination status, use of antibiotics and steroids. To investigate the prevalence of PPV-23 and 13-valent pneumococcal conjugate vaccine (PCV-13) serotypes within the study cohort.
Design A non-interventional, observational, prospective cohort study with a 12 -month follow-up period inclusive of quarterly study visits.
Setting Beaumont Hospital and The Royal College of Surgeons in Ireland Clinical Research Centre, Dublin, Ireland.
Participants Patients with an established diagnosis of COPD attending a tertiary medical centre.
Primary outcome measure Colonisation rate of S. pneumoniae in patients with COPD and characterisation of serotypes of S. pneumoniae with correlation to currently available pneumococcal vaccines. Sputum and oropharyngeal swab samples were collected for the isolation of S. pneumoniae.
Secondary outcome measure Seasonality of colonisation of S. pneumoniae and its relationship with the incidence of exacerbations of COPD.
Results S. pneumoniae was detected in 16 of 417 samples, a colonisation incident rate of 3.8% and in 11 of 133 (8%) patients at least once during the study. The majority of S. pneumoniae isolates were identified in spring and were non-vaccine serotypes for either the PPV-23 or PCV-13 (63%). The colonisation incident rate of S. pneumoniae fluctuated over the four seasons with a peak of 6.6% in spring and the lowest rate of 2.2% occurring during winter. Antibiotic use was highest during periods of low colonisation.
Conclusions There is seasonal variation in S. pneumoniae colonisation among patients with COPD which may reflect antibiotic use in autumn and winter. The predominance of non-vaccine types suggests that PCV-13 may have limited impact among patients with COPD in Ireland who currently receive PPV-23.
Trial registration number NCT02535546; post-results.
- chronic obstructive pulmonary disease
- Streptococcus pneumoniae
- pneumococcal vaccine
- colonisation
- serotype
- pneumonia
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Footnotes
Contributors HH and RWC conceptualised the study and participated in its design with assitstance from EMH and IS. HMC and MJ coordinated the study, conducted recruitment of patients and study visits and prepared samples for analysis. MC and MME conducted serotyping analysis. HMC analysed the data and IS and BC provided statistical analysis. HMC, HH and RWC drafted the manuscript. All authors read and approved the final manuscript.
Funding This study was funded through an unrestricted research grant from Pfizer (Ireland). The design and organisation of the research was decided solely by the researchers.
Competing interests HH is in receipt of research funds from Astellas and has in the recent past received lecture or consultancy fees from Novartis, Astellas, Cepheid and Astra Zeneca. All other authors have no declarations to make.
Patient consent This is not required as all patients who consented to participation in the study were also consented to the study's publication.
Ethics approval Ethics (Medical Research) Committee of Beaumont Hospital in December 2013.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data available.