Background With higher valency pneumococcal vaccines on the horizon and new adult immunisation strategies under discussion, we aimed to evaluate the contribution of individual pneumococcal serotypes to the burden of pneumococcal community-acquired pneumonia (CAP). Over 10 years, trends in pneumococcal pneumonia epidemiology in adults hospitalised with CAP were assessed. The risk factors and severity associated with serotype 3 were examined. Methods We conducted a prospective cohort study of adults hospitalised with CAP between September 2013 and May 2023. Pneumococcal serotypes were identified using a serotype-specific 24-valent urinary-antigen assay. Trends in the proportion of CAP due to pneumococcus and causative serotypes were compared prepandemic and postpandemic. Risk factors and severity of serotype 3 pneumonia were compared with other serotypes using logistic regression. Results Of 5186 patients with CAP, 2193 (42.2%) had pneumococcal pneumonia. The proportion of CAP due to pneumococcus increased across all ages between 2013 and 2023 (36.4%–66.9%, p<0.001). The proportion due to serotype 3 increased significantly from 13.4% (2013) to 48.8% (2023). Serotype 3 pneumonia in adults was associated with older age (p<0.001), male sex (adjusted OR (aOR) 2.22, 95% CI 1.64 to 3.01) and chronic renal disease (aOR 1.81, 95% CI 1.09 to 3.02). Serotype 3 pneumonia was not observed to be associated with severity, critical care requirement, mortality or readmission. Interpretation Serotype 3 is the predominant serotype in adult pneumococcal CAP and has been increasing despite a mature infant pneumococcal immunisation programme, consistent with a lack of herd protection for this serotype. Data are available on reasonable request.

中文翻译：

---

10 年（2013-2023 年）社区获得性肺炎住院成人肺炎的肺炎球菌肺炎趋势和血清型 3 的作用


背景 随着更高效价肺炎球菌疫苗的出现和新的成人免疫策略的讨论，我们旨在评估个体肺炎球菌血清型对肺炎球菌社区获得性肺炎 （CAP） 负担的贡献。10 多年来，评估了 CAP 住院成人肺炎肺炎流行病学的趋势。检查与血清型 3 相关的危险因素和严重程度。方法 我们对 2013 年 9 月至 2023 年 5 月期间因 CAP 住院的成人进行了一项前瞻性队列研究。使用血清型特异性 24 价尿液抗原测定法鉴定肺炎球菌血清型。比较了大流行前和大流行后肺炎球菌引起的 CAP 比例和致病血清型的趋势。使用 logistic 回归将血清型 3 肺炎的危险因素和严重程度与其他血清型进行比较。结果 5186 例 CAP 患者中，2193 例 （42.2%） 患有肺炎球菌性肺炎。2013 年至 2023 年期间，所有年龄段的肺炎球菌引起的 CAP 比例均有所增加 （36.4%–66.9%，p<0.001）。血清型 3 引起的比例从 13.4%（2013 年）显着增加到 48.8%（2023 年）。成人血清型 3 肺炎与高龄 （p<0.001）、男性 （校正 OR （aOR） 2.22,95% CI 1.64 至 3.01）和慢性肾病 （aOR 1.81,95% CI 1.09 至 3.02） 相关。未观察到血清型 3 肺炎与严重程度、重症监护需求、死亡率或再入院相关。解释血清型 3 是成人肺炎球菌 CAP 中的主要血清型，尽管婴儿肺炎球菌免疫接种计划已经成熟，但血清型 3 一直在增加，这与缺乏对该血清型的群体保护一致。数据可应合理要求提供。