Prospective multicentre hospital surveillance of Streptococcus pneumoniae disease in India

Background Although Streptococcus pneumoniae is recognised as an important cause of morbidity and mortality worldwide, in India few data are available on the pattern of invasive disease, serogroup/type prevalence, and antimic robial susceptibility pattern of the organism. Methods We studied the characteristics of invasive pneumococcal infections in six hospitals in India over 4 years, in patients with suspected pneumoni a (3686), pyogenic meningitis (1107), septicaemia (257), or localised pus-f orming lesions (688). Blood, cerebrospinal fluid (CSF), or other normally s terile body fluids were cultured, and CSF was tested for pneumococcal antig ens. All pneumococcal isolates were serotyped and their antimicrobial susce ptibility tested by standard methods. Findings S pneumoniae was isolated from blood, other normally sterile body fluids, or deep-seated pus in 307 patients, and antigen was detected in CSF in a further seven. 71 patients were younger than 2.0 years, 32 were 2.0-4 .9 years, and 211 were older than 5.0 years. The clinical syndromes associa ted with pneumococcal infection were meningitis (117; case-fatality rate 34 %), pneumonia (93; 19%), septicaemia (24; 21%), peritonitis (23; 4%), and o thers (empyema thoracis, pericarditis, or arthritis 57; 6%). Overall, 215 ( 70%) of the isolates were of serotypes 1, 6, 19, 7, 5, 15, 14, 4, 16, and 1 8 tin order of frequency). The most common serotypes in children under 5 ye ars were 6, 1, 19, 14, 4, 5, 45, 12, and 7, Serotypes 1 and 5 accounted for 29% (92 of 314) of disease. Intermediate resistance to penicillin was note d in only four (1.3%) isolates; however, resistance to cotrimoxazole (trime thoprim-sulphamethoxazole) and chloramphenicol was seen in 173 (56%) and 51 (17%) isolates, respectively. Interpretation Hospital-based surveillance of community-acquired infections can provide data useful for planning. Two pneumococcol serotypes accounted for a significant proportion of the disease. Although penicillin resistanc e was infrequently present, continued surveillance will be prudent.