Abstract Background Pneumococcal disease (PD) is a leading cause of morbidity among US children, particularly those with chronic medical conditions (CMC) and immunocompromising conditions (IC), and the decline in PD incidence was less pronounced in the late pneumococcal conjugate vaccine (PCV) 13 period. This study quantified healthcare resource utilization (HCRU) and costs among commercially and Medicaid-insured children with PD. Methods This retrospective observational cohort study used Merative™ MarketScan® Commercial Database and Multi-State Medicaid Databases to identify children with invasive pneumococcal disease (IPD), all-cause pneumonia (ACP), and acute otitis media (AOM) episodes using inpatient and outpatient claims. HCRU and costs per PD episode were assessed in the commercially and Medicaid-insured populations, stratified by age (<2, 2-4, and 5-17 years) and risk group (CMC, IC, and no CMC/IC). Results Between 2018 and 2023, commercially insured children contributed 23.6 million person-years (PY) and Medicaid-insured children contributed 23.4 million PY; 423 and 664 children had IPD, 309,540 and 281,569 had ACP, and 2,721,354 and 2,596,201 had AOM in the commercial and Medicaid populations, respectively. In both databases, HCRU and cost was higher in children with CMC or IC, compared to no CMC/IC across age groups for all PD manifestations. For IPD and ACP, inpatient admissions were 1.4 to 2.2-fold longer for children with CMC or IC. For IPD, costs per episode were 2-to-3-fold higher in children with CMC or IC, compared with those without CMC/IC (Commercial: $76,278 and $72,130 vs. $22,371; Medicaid: $17,389 and $19,945 vs. $6,476, respectively). For ACP, costs were highest in children with IC, followed by CMC and no CMC/IC (Commercial: $7,343, $2,637, and $809; Medicaid: $3,257, $1,160, and $356, respectively). AOM showed a similar pattern, with highest costs in children with IC (Commercial: $608; Medicaid: $178), followed by CMC ($442; $141), and lowest in those without CMC/IC ($368; $123). Conclusions US children with underlying conditions that increase susceptibility to PD experience substantially higher HCRU and costs compared with those without such conditions, across all PD manifestations, regardless of insurance type and age group. These findings underscore the need for risk-based prevention strategies, including vaccination, beyond early childhood in high-risk pediatric populations.
Streptococcus pneumoniae is a leading cause of community-acquired pneumonia (CAP) in adults, yet microbiological diagnosis remains challenging. Quantitative lytA-PCR on nasopharyngeal samples has improved diagnostic yield; however, a substantial proportion of patients with confirmed pneumococcal pneumonia (PPn) remain lytA-negative. We hypothesized that nasopharyngeal microbiota profiles differ according to lytA-PCR status on nasopharynx and may reflect distinct pathogenetic pathways. We conducted a prospective, observational study including adults hospitalized with confirmed PPn. Nasopharyngeal samples were collected before initiation of antimicrobial therapy for lytA-PCR quantification and 16S rRNA gene sequencing. Patients were stratified according to nasopharyngeal lytA-PCR status. Microbiota diversity and composition were analysed at the genus and amplicon sequence variant (ASV) levels. Differential abundance was assessed using ALDEx2, and associations between pneumococcal load and Streptococcus ASVs were explored. Among 38 patients, 24 (63
It has been reported that the introduction of thirteen-valent pneumococcal conjugate vaccine (PCV13) had an influence on antibiotic resistance rates of invasive pneumococcal disease (IPD). Recent data about antibiotic resistance in IPD are scarce. The aim of the current study was to analyse the impact of PCV13 introduction and COVID-19 pandemic on antibiotic resistance in IPD and the effects of antibiotic resistance on mortality. Furthermore, we correlate vaccine and non-vaccine serotypes with antibiotic resistance. We included 8747 IPD cases from a Swiss nationwide IPD surveillance database for 2012–2022. Regression analyses were performed to examine significant trends over time and to identify serotypes and patient characteristics associated with antibiotic resistance. The proportion of non-susceptibility to erythromycin (IRR: 0.9, p < 0.001) and cotrimoxazole (IRR: 0.9, p < 0.001) decreased from 2012 to 2022. Penicillin non-susceptibility remained constant with a dip in 2022 (2012: 9.2
Abstract Adjunctive corticosteroids are increasingly used in Severe Community-Acquired Pneumonia (sCAP) requiring admission to the intensive care unit (ICU), based on evidence derived largely from immunocompetent populations. Immunocompromised hosts, however, represent a distinct and growing subgroup among critically ill patients with sCAP, characterised by baseline immune defects, broader pathogen spectra, and a heightened susceptibility to treatment-related harm. Whether corticosteroid strategies validated in the general population can be safely and effectively extrapolated to immunocompromised ICU patients with sCAP remains uncertain, despite their growing use in contemporary ICU practice. Immunocompromised patients admitted to the ICU with sCAP experience compounded alterations in host defence, driven by pre-existing immune dysfunction and superimposed critical illness–associated immune dysregulation. In this setting, corticosteroids may attenuate inflammation-mediated lung injury, but may also deepen immune suppression, distort clinical evolution, and increase susceptibility to opportunistic superinfections and pathogen reactivation. Randomised trials and meta-analyses supporting corticosteroid use in sCAP have systematically excluded immunocompromised patients, treating immunosuppression as an exclusion criterion rather than a stratification variable, and commonly rely on short-term endpoints that fail to capture delayed infectious complications relevant to this population. Available observational data and pathogen-specific evidence suggest substantial heterogeneity of treatment effect (HTE) across immunocompromised subgroups, influenced by immune substrate, pathogen context, and cumulative immunosuppressive burden. Among the pathogen-specific contexts in which corticosteroids have the strongest evidence, Pneumocystis jirovecii pneumonia (PJP) stands out as the principal indication: adjunctive corticosteroids have demonstrated clear mortality benefit in AIDS-associated severe PJP, though this benefit does not extend uniformly to HIV-negative immunocompromised patients with PJP. Consequently, standard corticosteroid treatment in all CAP subgroups is unlikely to be appropriate. In immunocompromised ICU patients with sCAP, corticosteroid therapy should neither be routinely applied nor categorically avoided. Instead, decisions should be individualised, guided by a clearly defined therapeutic target, careful assessment of immune status, and consideration of the risk for opportunistic infections. When used, corticosteroids should be administered at the lowest effective dose and for the shortest feasible duration. Dedicated studies incorporating immune stratification, pathogen-informed approaches, and outcomes relevant to delayed infections are urgently needed. Until such evidence is available, careful risk-balance assessments to decide steroids in these patients.
Community-acquired pneumonia (CAP) is a leading cause of morbidity in adults with chronic conditions. Although pneumococcal vaccine effectiveness (VE) has been demonstrated in older adults, evidence is scant regarding adults < 65 years. We evaluated pneumococcal VE against CAP-related hospitalization in at-risk adults aged 18–64 years. We conducted a multicentre case-control study in Spain (2020–2024). Cases were adults aged 18–64 years with risk conditions, hospitalized for ≥ 24 h, with radiological and clinical patterns compatible with CAP. Controls were hospitalized patients with risk conditions but without pneumonia. Vaccination status was classified as 23-valent pneumococcal polysaccharide vaccine only, pneumococcal conjugate vaccine only, sequential vaccination, or unvaccinated. Logistic regression was used to estimate crude and adjusted odds ratio (OR) values, with VE calculated as (1–OR) × 100. Analyses were stratified by immune status, and a sensitivity analysis was performed excluding SARS-CoV-2 cases. We included 805 cases and 806 controls. None of the pneumococcal vaccination strategies showed significant effectiveness against hospitalization for CAP. In immunocompromised individuals, 23-valent pneumococcal polysaccharide vaccine showed significantly negative adjusted VE (-142.0, 95
