The role of Streptococcus pneumoniae in community-acquired pneumonia among adults in Europe: a meta-analysis

• Published in: European journal of clinical microbiology & infectious diseases Vol. 32; no. 3; pp. 305 - 316
• Main Authors: Rozenbaum, M. H., Pechlivanoglou, P., van der Werf, T. S., Lo-Ten-Foe, J. R., Postma, M. J., Hak, E.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.03.2013; Springer; Springer Nature B.V
• Subjects: Adult; Adults; Antibiotic resistance; Bacterial diseases; Biological and medical sciences; Biomedical and Life Sciences; Biomedicine; Chronic obstructive pulmonary disease; Community-Acquired Infections - epidemiology; Community-Acquired Infections - microbiology; Diagnostic tests; Economics; Europe - epidemiology; Human bacterial diseases; Humans; Immune system; Immunization; Infectious diseases; Intensive care units; Internal Medicine; Medical Microbiology; Medical sciences; Meta-analysis; Patients; Pneumology; Pneumonia; Pneumonia, Pneumococcal - epidemiology; Pneumonia, Pneumococcal - microbiology; Polymerase chain reaction; Prevalence; Respiratory system : syndromes and miscellaneous diseases; Review; Reviews; Serology; Staphylococcal infections, streptococcal infections, pneumococcal infections; Streptococcus infections; Streptococcus pneumoniae; Streptococcus pneumoniae - isolation & purification; Vaccines; Europe; Polymerase Chain Reaction Test; Pneumococcal Immunization; Diagnostic Polymerase Chain Reaction; Chronic Obstructive Pulmonary Disease; Invasive Pneumococcal Disease; Human; Lung disease; Pneumonia; Microbiology; Respiratory disease; Streptococcus pneumoniae; Infection; Streptococcaceae; Community acquired infection; Streptococcal infection; Bacteriosis; Bacteria; Micrococcales; Adult; Pneumococcal infection
• ISSN: 0934-9723; 1435-4373; 1435-4373
• DOI: 10.1007/s10096-012-1778-4

The primary objective of this meta-analysis was to estimate the prevalence of adult community-acquired pneumonia (CAP) caused by Streptococcus pneumoniae in Europe, adjusted for possible independent covariates. Two reviewers conducted a systematic literature search using PubMed on English-language articles that involved human subjects with CAP during the period from January 1990 to November 2011 across European countries. A mixed-effects meta-regression model was developed and populated with 24,410 patients obtained from 77 articles that met the inclusion criteria. The model showed that the observed prevalence of S. pneumoniae in CAP significantly varies between European regions, even after adjusting for explanatory covariates, including patient characteristics, diagnostic tests, antibiotic resistance, and health-care setting. The probability of detecting S. pneumoniae was substantially higher in studies that performed more frequently a diagnostic polymerase chain reaction assay compared to all the other diagnostic tests included. Furthermore, S. pneumoniae was more likely to be confirmed as the cause of a CAP in studies with intensive care unit patients as compared to those with hospital- or community-treated patients. This study provides estimates of the average observed prevalence of S. pneumoniae , which could be used for projecting the health and economic benefits of pneumococcal immunization.