Overview of pneumococcal serotypes and genotypes causing diseases in patients with chronic obstructive pulmonary disease in a Spanish hospital between 2013 and 2016

Overview of pneumococcal serotypes and genotypes causing diseases in patients with chronic obstructive pulmonary disease in a Spanish hospital between 2013 and 2016 Hisashi Shoji,1,* Daniel A Vázquez-Sánchez,1,* Aida Gonzalez-Diaz,1,2 Meritxell Cubero,1,2 Fe Tubau,1,2 Salud Santos,2,3 Dolores García-Somoza,1,2 Josefina Liñares,1,2 José Yuste,2,4 Sara Martí,1,2 Carmen Ardanuy1,2 1Microbiology Department, Hospital Universitari de Bellvitge, IDIBELL, University of Barcelona, Barcelona, Spain; 2CIBER de Enfermedades Respiratorias, ISCIII, Madrid, Spain; 3Respiratory Medicine Department, Hospital Universitari de Bellvitge, IDIBELL, University of Barcelona, Barcelona, Spain; 4Pneumococcal Reference Laboratory, Centro Nacional de Microbiología, ISCIII, Madrid, Spain *These authors contributed equally to this work Background: Streptococcus pneumoniae is an important pathogen in chronic obstructive pulmonary disease (COPD). We aimed at showing the recent changes in the epidemiology of pneumococcal diseases in patients with COPD, especially after the introduction of the 13-valent pneumococcal conjugate vaccine (PCV13).Methods: From 2013 to 2016, strains causing invasive pneumococcal disease (IPD), non-bacteremic pneumococcal pneumonia (non-BPP), and acute exacerbation of COPD (AE-COPD) were prospectively included. Antimicrobial susceptibility testing, serotyping, and genotyping were analyzed.Results: We collected 345 pneumococci from 286 COPD patients (57 IPD, 78 non-BPP, and 210 AE-COPD). The most frequent serotypes were serotypes 3 (14.0%), 8 (14.0%), and 12F (8.8%) in IPD; serotypes 3 (16.7%), 11A (9%), 9L/N (7.7%), and 23A (7.7%) in non-BPP; and serotypes 11A (11%), nontypeable (11%), and 6C (10%) in AE-COPD. Resistance rates were highest among AE-COPD strains. Penicillin resistance was associated with serotypes 11A (CC156) and 19A (CC320 and CC230). Compared with previous studies, fluoroquinolone resistance in AE-COPD increased (9.5%), PCV13 serotypes decreased (31.6%, 26.9%, and 16.7% for IPD, non-BPP, and AE-COPD, respectively), and serotype 11A-CC156 in AE-COPD and serotype 8 in IPD increased.Conclusion: The epidemiology of pneumococcal disease in COPD changed after the introduction of PCV13 in children. Increases in the highly invasive serotype 8 among patients with IPD and in serotype 11A-CC156 among patients with AE-COPD could compromise the ability of current PCVs to prevent diseases. Vaccines with a greater coverage could improve the benefits of adult vaccination. Keywords: Streptococcus pneumoniae, pneumococcal conjugate vaccine, chronic obstructive pulmonary disease, invasive pneumococcal disease