Upper airways colonisation of Streptococcus pneumoniae in adults aged 60 years and older: a systematic review of prevalence and individual participant data meta-analysis of risk factors

Smith, Emma, Wheeler, India, Adler, Hugh ORCID: https://orcid.org/0000-0003-4437-2298, Ferreira, Daniela ORCID: https://orcid.org/0000-0002-0594-0902, Sá-Leão, Raquel, Abdullahi, Osman, Adetifa, Ifedayo, Becker-Dreps, Sylvia, Esposito, Susanna, Farida, Helmia, Kandasamy, Rama, Mackenzie, Grant A., Nuorti, J. Pekka, Nzenze, Susan, Madhi, Shabir A., Ortega, Omar, Roca, Anna, Safari, Dodi, Schaumburg, Frieder, Usuf, Effua, Sanders, Elisabeth A.M., Grant, Lindsay R., Hammitt, Laura L., O'Brien, Katherine L., Gounder, Prabhu, Bruden, Dana J.T., Stanton, Michelle C. and Rylance, Jamie ORCID: https://orcid.org/0000-0002-2323-3611 (2020) 'Upper airways colonisation of Streptococcus pneumoniae in adults aged 60 years and older: a systematic review of prevalence and individual participant data meta-analysis of risk factors'. Journal of Infection, Vol 81, Issue 4, pp. 540-549.

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Abstract

Background
Colonisation with Streptococcus pneumoniae can lead to invasive pneumococcal disease and pneumonia. Pneumococcal acquisition and prevalence of colonisation are high in children. In older adults, a population susceptible to pneumococcal disease, colonisation prevalence is reported to be lower, but studies are heterogeneous.

Methods
This is a systematic review and meta-analysis of prevalence of, and risk factors for, pneumococcal colonisation in adults ≥ 60 years of age (PROSPERO #42016036891). We identified peer-reviewed studies reporting the prevalence of S. pneumoniae colonisation using MEDLINE and EMBASE (until April 2016), excluding studies of acute disease. Participant-level data on risk factors were sought from each study.

Findings
Of 2202 studies screened, 29 were analysable: 18 provided participant-level data (representing 6290 participants). Prevalence of detected pneumococcal colonisation was 0-39% by conventional culture methods and 3-23% by molecular methods. In a multivariate analysis, colonisation was higher in persons from nursing facilities compared with the community (odds ratio (OR) 2•30, 95% CI 1•26-4•21 and OR 7•72, 95% CI 1•15-51•85 respectively), in those who were currently smoking (OR 1•69, 95% CI 1•12-2•53) or those who had regular contact with children (OR 1•93, 95%CI 1•27-2•93). Persons living in urban areas had significantly lower carriage prevalence (OR 0•43, 95%CI 0•27-0•70).

Interpretation
Overall prevalence of pneumococcal colonisation in older adults was higher than expected but varied by risk factors. Future studies should further explore risk factors for colonisation, to highlight targets for focussed intervention such as pneumococcal vaccination of high-risk groups.

Item Type:	Article
Subjects:	QW Microbiology and Immunology > Bacteria > QW 142 Gram-positive bacteria (General) WC Communicable Diseases > Infection. Bacterial Infections > Bacterial Infections > WC 217 Pneumococcal infections WT Geriatrics. Chronic Disease > Geriatrics > WT 100 General works WT Geriatrics. Chronic Disease > WT 20 Research (General)
Faculty: Department:	Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI):	https://doi.org/10.1016/j.jinf.2020.06.028
SWORD Depositor:	JISC Pubrouter
Depositing User:	JISC Pubrouter
Date Deposited:	22 Jun 2020 10:11
Last Modified:	09 Nov 2020 11:56
URI:	https://archive.lstmed.ac.uk/id/eprint/14806

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