Invasive pneumococcal disease in adult hematopoietic stem cell transplant recipients: a decade of prospective population-based surveillance.

Prospective population-based surveillance to assess the epidemiology of invasive pneumococcal disease (IPD) in hematopoietic stem cell transplant (HSCT) patients is limited and a comparison to the general population is lacking. By using a population-based Invasive Bacterial Diseases Network surveillance program, we studied the incidence, clinical significance, serotypes and antimicrobial resistance of IPD in a large cohort of adult HSCT patients and the general population. Streptococcus pneumoniae isolates and patient data were collected prospectively from 1995 to 2004. We identified 14 cases of IPD (based on sterile site isolates) in our HSCT population over a 10-year period. This translated to an incidence rate of 347 infections per 100 000 persons per year. This compared to an incidence of 11.5 per 100 000 persons per year in the general population (regression ratio=30.2; 95% confidence interval (CI) 17.8-50.8, P<0.00001). If nonsterile site isolates (respiratory tract) were included, the incidence rate in transplant patients was 446 per 100 000 persons per year. Serotypes 23F and 6B were most common; 100 and 69.2% of isolates were a serotype included in the pneumococcal polysaccharide and conjugate vaccines, respectively. The antimicrobial resistance rates were high, especially for trimethoprim/sulfamethoxazole. HSCT recipients are at significantly greater risk for IPD than the general population. Preventative strategies are necessary.

Invasive pneumococcal disease in solid organ transplant recipients--10-year prospective population surveillance.

Prospective population-based surveillance to assess the incidence and impact of invasive pneumococcal disease (IPD) in organ transplant patients is lacking. By using a population-based Invasive Bacterial Diseases Network surveillance program, we studied the incidence, clinical significance, serotypes and antimicrobial resistance pattern of IPD in a large cohort of adult transplant patients and the general population. Streptococcus pneumoniae isolates and patient data were collected prospectively from 1995 to 2004. We identified 21 cases of IPD (based on sterile-site isolates) in our organ transplant population over a 10-year period. This translated to an incidence rate of 146 infections per 100,000 persons per year. This compared to an incidence of 11.5 per 100,000 persons per year in the general population (R(R)=12.8; 95% CI 8.1-19.9, p<0.00001). If nonsterile-site isolates (respiratory tract) were included, the incidence rate in transplant patients was 419 of 100 000 persons per year. Serotypes 23F and 22F were most common, and 85.0% had a serotype included in the 23-valent pneumococcal vaccine. The antimicrobial resistance rates were high, especially for penicillin and trimethoprim-sulfamethoxazole (TMP/SMX), but were not significantly different from the general population. Solid organ transplant recipients are at significantly greater risk for IPD than the general population. Preventative strategies are necessary.