Clinical Features of Invasive Pneumococcal Disease in Korea

Won Suk Choi; Ji Yun Noh; Joong Yeon Huh; Young Kyoung Youn; Mi Jeong Kim; Yu Mi Jo; Jeong Yeon Kim; Joon Young Song; Dae Won Park; Woo Joo Kim; Min Ja Kim; Hee Jin Cheong

doi:10.3947/ic.2010.42.3.156

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Choi, Noh, Huh, Youn, Kim, Jo, Kim, Song, Park, Kim, Kim, and Cheong: Clinical Features of Invasive Pneumococcal Disease in Korea

Original Article

Infection & Chemotherapy

Infection & Chemotherapy 2010; 42(3): 156-161.

Published online: 30 June 2010

DOI: https://doi.org/10.3947/ic.2010.42.3.156

Clinical Features of Invasive Pneumococcal Disease in Korea

Won Suk Choi, Ji Yun Noh, Joong Yeon Huh, Young Kyoung Youn, Mi Jeong Kim, Yu Mi Jo, Jeong Yeon Kim, Joon Young Song, Dae Won Park, Woo Joo Kim, Min Ja Kim, Hee Jin Cheong

Division of Infectious Disease, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.

Corresponding author: Hee Jin Cheong, M.D. Division of Infectious Disease, Department of Internal Medicine, Korea University College of Medicine, Korea University Guro Hospital, 97, Gurodong-gil, Guro-gu, Seoul 152-703, Korea. Tel: +82-2-2626-3050, Fax: +82-2-2626-1105, heejinmd@korea.ac.kr

Received 3 September 2009 Revised 16 March 2010 Accepted 22 March 2010

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Streptococcus pneumoniae is one of the most important causes of pneumonia, meningitis, bacteremia, and other invasive diseases in children and adults. The 23-valent polysaccharide pneumococcal vaccine (PPV) has been recommended to adults with high risk conditions by the Korea Society of Infectious Diseases in 2007, but there is no data on the epidemiology of invasive pneumococcal disease in Korean adults to support this recommendation. Therefore, we performed a study to investigate the epidemiology of invasive pneumococcal disease in Korean population.

Materials and Methods

We collected clinical and microbiologic data of patients diagnosed with invasive pneumococcal disease (IPD) in 3 university-hospitals located in Seoul and Gyeonggi-do from January 2002 to December 2007.

Results

A total of 168 patients were diagnosed with IPD in the selected hospitals during the study period. Invasive pneumonia and meningitis were the most common forms of IPDs. The mean length of hospitalization of patients with IPD was 18.5±26.7 days and mortality rate of IPD was 18.6%. Among the isolates from patients with IPD, 59.7% was susceptible to penicillin and 38.3% was susceptible to erythromycin. Mortality rate of IPD increased with age and in patients with Eastern Cooperative Oncology Group performance status 4.

Conclusions

Epidemiology of IPD in Korean population was described. Further studies should be performed to secure the risk factors of invasive pneumococcal diseases and to confirm the appropriateness of recommendation for vaccination with the 23-valent PPV.

Keywords: Streptococcus pneumoniae, Pneumococcal infections, epidemiology

Figures and Tables

Figure 1

Age distribution of cases with invasive pneumococcal disease (IPD) in 3 university hospitals in Korea from January 2002 to December 2007.

Figure 2

Distribution of clinical diagnoses of invasive pneumococcal disease (IPD) in 3 university hospitals in Korea from January 2002 to December 2007.

Figure 3

Antibiotic susceptibility of pneumococci isolated from patients with invasive pneumococcal disease in 3 university hospitals in Korea from January 2002 to December 2007. Some isolates did not have the result of susceptibility test to specific antibiotics in medical records. Among a total of 168 isolates, 164 (97.6%) had the result of susceptibility test to penicillin, 154 (91.7%) had the result of susceptibility test to erythromycin, 120 (71.4%) had the result of susceptibility test to cefotaxime, and 153 (91.1%) had the result of susceptibility test to levofloxacin.

Table 1

Distribution of Invasive Pneumococcal Disease according to Age Group

^*Others include septic arthritis, cholangitis, empyema without pneumonia, infective endocarditis, infected pseudocyst of pancreas, renal abscess, etc.

Table 2

Underlying Medical Conditions of Patients with Invasive Pneumococcal Disease according to Age Group

ECOG, Eastern Cooperative Oncology Group

^*Patients in each group may have several medical conditions.

^†Defined as alcohol use for more than 5 days a week or a diagnosis of alcoholism.

^‡Immunosuppressant includes chemotherapeutic agents for malignancy, steroid or other immune suppressive agents.

^§The Korean Society of Infectious Diseases recommended the 23-valent polysaccharide pneumococcal vaccine for all adults ≥65 years, and adults <65 years with chronic disorders of the pulmonary system (excluding asthma), cardiovascular diseases, diabetes mellitus, chronic liver diseases, chronic renal failure, nephrotic syndrome, functional or anatominal asplenia, splenectomy, immunosuppressive conditions (e.g., HIV infection, leukemia, lymphoma, multiple myeloma, Hodgkin disease, generalized malignancy, or organ or bone marrow transplantation), or chemotherapy with alkylating agents, antimetabolites or high-dose, long-term corticosteroids.

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