S. pneumoniae prevalence and serotypes in sputum of stable bronchiectasis

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There is limited evidence on the administration of pneumococcal vaccine in adults with bronchiectasis (BE), as well as on prevalence and serotypes of S. pneumoniae (SP) in sputum of stable BE patients. An observational prospective study enrolling adults with non-CF BE was conducted at the Bronchiectasis and PCD Program of the Policlinico Hospital in Milan, Italy, between 2017 and 2018, to address this issue. SP DNA was extracted from sputum samples and screened in duplicate by RT-PCR using specific TaqMan assay. Positive samples were serotyped by RT-PCR using TaqMan assay (33 serotypes). Among the 149 patients enrolled (female 77%, median age: 63 years), SP was found in 41 (28%) patients and the most prevalent serotypes were 19BF (13%), 24ABF (12%), 9VA (6%), 35B (4%), 15AF (3%), 6CD (2%), and 22AF (2%). Co-infections by were reported in 17% of the patients. At the time of sputum collection, 95 (64%) BE patients were vaccinated with PCV13, 61 (41%) with PPV23, and 46 (31%) with both vaccinations. 33 were vaccine-naïve, 9 (27%) were RT-PCR SP positive, with 19BF (15%), 24ABF (12%), 9VA (9%), and 35B (6%). RT-PCR for SP positivity was negatively correlated with the Bronchiectasis Severity Index (BSI) (rho=-0.21, P=0.01), being more prevalent in patients with mild than in those with moderate/severe disease. SP DNA copies /mL were also negatively correlated with both BSI (rho=-0.23, P=0.006) and FACED (rho=-0.18, P=0.03) scores. SP Prevalence in sputum of stable BE patients is higher than that reported in literature in nasopharyngeal swabs of healthy subjects, although its role in determining adverse clinical outcomes in BE is unclear

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