892. Burden of Community Acquired Pneumonia and Invasive Pneumococcal Disease amongst Hospitalized Canadian Adults: A Public Health Agency of Canada/Canadian Institutes of Health Research (PCIRN) Serious Outcomes Surveillance Network Study
Session: Poster Abstract Session: Respiratory Infections
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Background: Community acquired pneumonia (CAP) and invasive pneumococcal disease (IPD) are important contributors to morbidity and mortality among Canadian adults. Adult immunization with  polysaccharide pneumococcal vaccines results in suboptimal disease prevention. Establishing burden of disease and healthcare utilization associated with CAP and IPD in Canada is critical to inform immunization policy for conjugate pneumococcal vaccine use in adults and to facilitate program evaluation.

Methods: The PCIRN Serious Outcomes Surveillance (SOS) Network comprises 43 adult hospitals and ~17000 beds in 7 provinces. We conducted active surveillance for CAP and IPD in 9 SOS Network sites from 12/1/10 to 12/31/12. Surveillance monitors reviewed hospitalizations daily and enrolled consenting aduts admitted with CAP or IPD. Detailed information regarding comorbidities, hospital course and outcomes were collected. Where possible, sputum and blood cultures and urine for pneumococcal urinary antigen (Binax) were collected.

Results: 2855 cases of CAP were enrolled; mean age 67.7y (17-104y); 54% were male; 37.8% >75y. 92.8% had ≥ 1 co-morbidities; 28% were immunocompromised. 31% had received pneumococcal vaccine (unknown in 35%). Mean length of stay (LOS) was 13.9d (1-738d). 10.4% developed cardiac complications, 21.4% required admission to ICU and 15.6% were ventilated. Among 1785 patients ≥ 65y, mean frail scale scores increased from 4.2 at baseline to 4.4 at 30d (p=0.02); 30d mortality was 11.1%.  Overall, Spn infection was confirmed in 212 (7.4%) of patients with CAP: 133 had + blood culture, 71 had + sputum cultures, and 33 had + streptoccocal urinary antigen (UA) (311 patients had a UA performed of which 33 (11%) were positive; 29/33 of these were positive for Spn only by UA). 243 cases of IPD were enrolled. Mean age 60.2y and mean LOS was 19.8d (1-72d); 50.6% were admitted to ICU and 37% required ventilation. 30d mortality was 18.1%. 

Conclusion: CAP and IPD are associated with considerable morbidity, mortality, and healthcare utilization amongst adults. Admission for CAP leads to increased frailty in older adults and assessment of burden of disease and cost-effectiveness of immunization programs should address this. Improved prevention of pneumococcal disease may result in significant cost savings.

Shelly Mcneil, MD, FIDSA1, Ardith Ambrose, RN1, Melissa Andrew, MD, PhD1,2, Guy Boivin, MD3,4, William Bowie, MD, FRCPC5, May Elsherif, MD1, Karen Green, MSc6, Todd Hatchette, MD1, Jennie Johnstone, MD7, Jason Leblanc, PhD1, Mark Loeb, MD, MSc7, Donna Mackinnon-Cameron, MMath1, Thomas Marrie, MD8, Anne Mccarthy, MD, MSc9, Allison McGeer, MD, MSc, FRCPC, FSHEA10,11, Makeda Semret, MD12, Grant Stiver, MD13, Sylvie Trottier, MD14, Louis Valiquette, MD, MSc15, Hongyue Wang, MSc1, Duncan Webster, MD16, Lingyun Ye, PhD1 and on behalf of the Public Health Agency of Canada/Canadian Institutes of Health Research Influenza Research Network (PCIRN) Serious Outcomes Surveillance Network Investigators, (1)Canadian Center for Vaccinology, IWK Health Centre and Capital Health, Dalhousie University, Halifax, NS, Canada, (2)Division of Geriatric Medicine, Capital Health, Dalhousie University, Halifax, NS, Canada, (3)Centre Hospitalier Universitaire de Québec, Quebec, QC, Canada, (4)Laval University, Qeubec, QC, Canada, (5)University of British Columbia, Vancouver, BC, Canada, (6)Microbiology, Mount Sinai Hospital, Toronto, ON, Canada, (7)McMaster University, Hamilton, ON, Canada, (8)Medicine, Dalhousie University, Nova Scotia, NS, Canada, (9)Ottawa Hospital General Campus, Ottawa, ON, Canada, (10)Infection Prevention and Control, Mount Sinai Hospital, Toronto, ON, Canada, (11)Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, (12)McGill University, Montreal, QC, Canada, (13)University of British Columbia, Vancouver General, Vancouver, BC, Canada, (14)Hopital Laval, Ste-Foy, QC, Canada, (15)Department of Microbiology and Infectious Diseases, Université de Sherbrooke, Sherbrooke, QC, Canada, (16)Horizon Health, St. John, NB, Canada

Disclosures:

S. Mcneil, Pfizer Canada: Grant Investigator, Research grant

A. Ambrose, Pfizer Canada: Grant Investigator, Research grant

M. Andrew, Pfizer Canada: Grant Investigator, Research grant

G. Boivin, Pfizer Canada: Grant Investigator, Research grant

W. Bowie, Pfizer Canada: Grant Investigator and Investigator, Research grant

M. Elsherif, Pfizer Canada: Grant Investigator, Research grant

K. Green, Pfizer Canada: Grant Investigator, Research grant

T. Hatchette, Pfizer Canada: Grant Investigator, Research grant

J. Johnstone, Pfizer Canada: Grant Investigator, Research grant

J. Leblanc, Pfizer Canada: Grant Investigator, Grant recipient

M. Loeb, Pfizer Canada: Grant Investigator, Research grant

D. Mackinnon-Cameron, Pfizer Canada: Grant Investigator, Research grant

T. Marrie, Pfizer Canada: Grant Investigator, Research grant

A. Mccarthy, Pfizer Canada: Grant Investigator, Research grant

A. McGeer, Pfizer Canada: Grant Investigator, Research grant

M. Semret, Pfizer Canada: Grant Investigator, Research grant

G. Stiver, Pfizer Canada: Grant Investigator, Research grant

S. Trottier, Pfizer Canada: Grant Investigator, Research grant

L. Valiquette, Pfizer: Collaborator, Investigator and Speaker's Bureau, Research grant and Speaker honorarium
Wyeth: Investigator and Speaker's Bureau, Research grant and Speaker honorarium

H. Wang, Pfizer Canada: Grant Investigator, Research grant

D. Webster, Pfizer Canada: Grant Investigator, Research grant

L. Ye, Pfizer Canada: Grant Investigator, Research grant

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