Abstract Rationale Lower respiratory tract infections—particularly community-acquired pneumonia (CAP)—remain the leading cause of infectious disease mortality worldwide, responsible for approximately 1.6 million deaths annually. Streptococcus pneumoniae remains the primary etiologic agent. CAP incidence ranges from 1.6 to 13.6 per 1,000 inhabitants, increasing sharply with age due to immunosenescence and comorbidities. In Panama, pneumonia consistently ranks among the top ten causes of death. A previous study in Chiriquí (INACHI50+) reported an incidence of 247 per 100,000 and a fatality rate of 11% in adults ≥50 years. This study updates local data, focusing on serotype distribution and mortality. Methods A retrospective, multicenter, population-based study was conducted over 24 months in Chiriquí Province, Panama, among adults aged ≥50 years with clinical and radiographic evidence of CAP. Diagnostic work-up included blood and sputum cultures, Gram stain, nasopharyngeal PCR for respiratory viruses, and urinary antigen detection (BinaxNOW® and UAD™ assays) for S. pneumoniae and PCV13-specific serotypes. Urine samples were stored at − 70 °C and analyzed at Pfizer VREED laboratories (New York, USA) for serotype identification. Results Of 258 patients enrolled, 80% required hospitalization and 30-day mortality was 11%. S. pneumoniae accounted for 25-30% of microbiologically confirmed CAP cases. UAD testing identified serotypes 3, 19A, 6A, 6B, 14, and 23F as predominant (PCV13-covered). Additional serotypes 8, 10A, 11A, 15B, 22F, and 33F represented an extra 20% of pneumococcal cases. Mortality was highest among infections with serotypes 3 and 19A and in those with elevated CRB-65 scores. Conclusions Streptococcus pneumoniae remains a leading cause of severe CAP and death among older adults in Panama. The persistence of vaccine-covered serotypes and emergence of additional PCV20 types highlight the dynamic pneumococcal landscape. These findings reinforce the urgent need for continuous pneumococcal surveillance and broader vaccine coverage. Preventable deaths from pneumococcal disease remain an ethical and public health challenge. This abstract is funded by: Pfizer
Rodriguez et al. (Fri,) studied this question.