Pneumococcal disease burden in various body sites becomes a pressing public health matter in India. Globally, it is considered the fourth-deadliest pathogen in terms of mortality linked to or resulting from antimicrobial resistance. The true burden is yet to be fully understood, as its true magnitude remains elusive. Even though Indian research has consistently shown a high occurrence of invasive pneumococcal infections and a substantial infection pressure across all age groups, there is a scarcity of information on the pneumococcal serotypes responsible for non-invasive infections in India. Existing studies have primarily focused on invasive pneumococcal disease or a combination of both invasive and non-invasive infections, resulting in a significant knowledge gap regarding non-invasive disease, despite regular publication of data on invasive isolates. Moreover studies are mainly concentrated on pediatric and old age group. Exclusive reliance on invasive pneumococcal infections data may lead to an incomplete assessment of the total pneumococcal infection burden, as it neglects the contribution of non-invasive infections to the overall disease load. The existing reports, based on observational studies, lack laboratory confirmation and exhibit significant heterogeneity in terms of case definition, laboratory techniques, duration, and geographic scope. Consequently, there is a pressing need for up-to-date, regionally representative baseline data on serotype distribution, antibiotic resistance patterns, and vaccine coverage to inform evidence-based public health decisions. To isolate S. pneumoniae from Blood, cerebrospinal fluid, pleural fluid, other sterile body fluids, ear, eye, nasopharynx and lower respiratory tract specimens and to list reported clinical symptoms associated with pneumococcal disease and associated co-morbidities, if any. Also, to identify the prevalent serotypes and evaluate the antibiotic susceptibility patterns of the infecting strains. Clinical syndrome-based site samples are collected from patients based on routine clinical practice followed in hospital. Sterile specimens are loaded in to BACT/ALERT 3D microbial identification system and Other non-invasive specimens are examined using standard bacteriological methods. Optochin sensitive gram-positive cocci are processed for identification in Vitek 2 Compact (BioMerieux) and antimicrobial susceptibility is done by Kirby-Bauer disk diffusion method or Automated ID/AST system. Pneumococcal isolates are sub-cultured and transported to the Central Research Laboratory at KIMS Medical College, Bangalore for serotyping. During the specified period, a total of 12,180 samples were received, out of which S. pneumoniae are isolated from 53 (0.4%) samples. Among the 53 samples the majority (n=31) were obtained from invasive specimens and the remaining 22 specimens were collected from non-invasive site. The targets enrolled were categorized into six age groups, the majority being adults (52.8%), with male (66.1%) being more frequently affected. Out of 53 patients, 30 patients presented with at least one comorbidity. The most common risk factor for pneumococcal infection were respiratory disease (26.4%) and diabetes (24.5%). A total of 16 different serotypes were identified, 19F was the most common serotype in our population. 52 isolates showed antibiotic resistance to at least one of the tested antimicrobials while only one isolate was fully susceptible to all tested antimicrobials. This study provides valuable insights into the incidence, antibiotic susceptibility patterns, and serotype distribution of Streptococcus pneumoniae. Our findings highlight the ongoing threat of pneumococcal infections, particularly among vulnerable populations, and emphasize the need for sustained surveillance, prudent antibiotic use, and targeted vaccination strategies. Our results have significant implications for healthcare policies, vaccine development, and antimicrobial stewardship initiatives, ultimately aiming to reduce the burden of pneumococcal infections and improve patient outcomes.
Adila et al. (Sun,) studied this question.