[Severe pneumococcal infections in the elderly - preventable by vaccination.]
ABSTRACT Elderly people are more susceptible to pneumococcal infections. Data in Germany from 2005-2010 shows that especially seniors are prone to develop serious complications such as sepsis. Women are obviously less affected than men. Most of the infections occurred during the winter months. The majority of isolates, i.e., about 80%, possess capsular polysaccharide antigens which are represented in the 23-valent vaccine. Consequently, it could be assumed that the severe complications ensuing long hospital stays and associated with a high mortality could have been avoided, if the elderly people would have been vaccinated, which, however, was only true in a small proportion (28%). Recently, a new conjugated vaccine was introduced to the market. In principle, several antibiotics are available for direct antibacterial treatment. All isolates are susceptible to cefotaxime as well as to ceftriaxone. Resistance to penicillin as well as ampicillin is very rare in Germany. The vast majority of isolates are susceptible to quinolones such as levofloxacin and moxifloxacin. Resistance to macrolides, for example to erythromycin, occurs to a certain extent but the percentage has been declining in recent years. Nevertheless, in many instances therapy is too late. Thus, prevention is of great importance.
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ABSTRACT: We performed a prospective, international, observational study of 844 hospitalized patients with blood cultures positive for Streptococcus pneumoniae. Fifteen percent of isolates had in vitro intermediate susceptibility to penicillin (minimum inhibitory concentration [MIC], 0.12-1 microg/mL), and 9.6% of isolates were resistant (MIC, >or=2 microg/mL). Age, severity of illness, and underlying disease with immunosuppression were significantly associated with mortality; penicillin resistance was not a risk factor for mortality. The impact of concordant antibiotic therapy (i.e., receipt of a single antibiotic with in vitro activity against S. pneumoniae) versus discordant therapy (inactive in vitro) on mortality was assessed at 14 days. Discordant therapy with penicillins, cefotaxime, and ceftriaxone (but not cefuroxime) did not result in a higher mortality rate. Similarly, time required for defervescence and frequency of suppurative complications were not associated with concordance of beta-lactam antibiotic therapy. beta-Lactam antibiotics should still be useful for treatment of pneumococcal infections that do not involve cerebrospinal fluid, regardless of in vitro susceptibility, as determined by current NCCLS breakpoints.Clinical Infectious Diseases 08/2003; 37(2):230-7. · 9.42 Impact Factor
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ABSTRACT: The polysaccharide capsule of Streptococcus pneumoniae inhibits phagocytic killing by innate immune mechanisms. Certain serotypes are associated with invasive disease while others with a nasopharyngeal carriage. The invasiveness of serotypes may partly be explained by ability to resist deposition of complement (C3) on the bacterial surface and consequent opsonophagocytic killing. In our previous studies, we observed that clinical isolates of serotypes 1 and 5, which are rarely detected in asymptomatic carriage, were resistant to complement deposition and opsonophagocytosis, whereas serotypes 6B and 23F, both common in carriage, were more sensitive to deposition of C3 and opsonophagocytic killing. However, presence of significant variation in C3 deposition between isolates of the same serotype indicated that factors other than the capsule also affect complement resistance. To distinguish the relative effect of the capsular serotype and other virulence factors on C3 deposition, we compared capsule-switched mutants prepared in genetic backgrounds of pneumococcal strains TIGR4, 603, and 618. Clinical isolates which had the same multilocus sequence type but expressed different serotypes were also compared. We found that the serotype had a significant impact on complement resistance and that the more resistant the strain was to complement, the higher was the concentration of polysaccharide-specific antibodies required for opsonophagocytic killing. Comparison of strains expressing the same capsular polysaccharides in the different genetic backgrounds and various capsular mutants of the same strain suggests that while the genotype affects complement resistance, the serotype is the most important determinant. Differences between serotypes were more significant than the differences between strains.Infection and immunity 12/2010; 78(12):5262-70. · 4.16 Impact Factor
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ABSTRACT: Diseases caused by pneumococci and influenza viruses can lead to severe complications in children, in older, chronically ill and immunosuppressed patients. In an aging population in western countries they present an important cause of morbidity and mortality. Additionally, antibiotic resistance may complicate a therapy. Consequently, the need of an effective vaccine is obvious. The 23-valent polysaccharide pneumococcal vaccine has been discussed critically. New meta-analyses do not show an efficacy in preventing invasive pneumococcal disease or death of all cause. However, a very recent study has shown a significant reduction of pneumonias and death due to pneumococcal disease in nursing-home residents. The 7-valent conjugated vaccine is more immunogenic and efficient in children and first studies demonstrate its efficacy in immunosuppressed persons. In Switzerland this latter vaccine is used in children, in Germany the 7-valent vaccine has been replaced by the 13-valent conjugated vaccine since December 2009. Influenza-vaccines are effective, while vaccines with an adjuvance seem more immunogenic, in particular in older persons. The 2010/2011 influenza vaccine has been adapted and includes the pandemic influenza H1N1 2009 strain. The influenza vaccine often does not provide protection against infection, however, it does provide good efficacy against severe complications related to influenza.Der Internist 10/2010; 52(3):265-76. · 0.27 Impact Factor