Prospective multicentre hospital surveillance of Streptococcus pneumoniae disease in India. Invasive Bacterial Infection Surveillance (IBIS) Group, International Clinical Epidemiology Network (INCLEN)

Abstract

Although Streptococcus pneumoniae is recognised as an important cause of morbidity and mortality worldwide, in India few data are available on the pattern of invasive disease, serogroup/type prevalence, and antimicrobial susceptibility pattern of the organism. We studied the characteristics of invasive pneumococcal infections in six hospitals in India over 4 years, in patients with suspected pneumonia (3686), pyogenic meningitis (1107), septicaemia (257), or localised pus-forming lesions (688). Blood, cerebrospinal fluid (CSF), or other normally sterile body fluids were cultured, and CSF was tested for pneumococcal antigens. All pneumococcal isolates were serotyped and their antimicrobial susceptibility tested by standard methods. S. pneumoniae was isolated from blood, other normally sterile body fluids, or deep-seated pus in 307 patients, and antigen was detected in CSF in a further seven. 71 patients were younger than 2.0 years, 32 were 2.0-4.9 years, and 211 were older than 5.0 years. The clinical syndromes associated with pneumococcal infection were meningitis (117; case-fatality rate 34%), pneumonia (93; 19%), septicaemia (24; 21%), peritonitis (23; 4%), and others (empyema thoracis, pericarditis, or arthritis 57; 6%). Overall, 215 (70%) of the isolates were of serotypes 1, 6, 19, 7, 5, 15, 14, 4, 16, and 18 (in order of frequency). The most common serotypes in children under 5 years were 6, 1, 19, 14, 4, 5, 45, 12, and 7. Serotypes 1 and 5 accounted for 29% (92 of 314) of disease. Intermediate resistance to penicillin was noted in only four (1.3%) isolates; however, resistance to co-trimoxazole (trimethoprim-sulphamethoxazole) and chloramphenicol was seen in 173 (56%) and 51 (17%) isolates, respectively. Hospital-based surveillance of community-acquired infections can provide data useful for planning. Two pneumococcol serotypes accounted for a significant proportion of the disease. Although penicillin resistance was infrequently present, continued surveillance will be prudent.