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Volume 28, Number 1—January 2022
Research

Streptococcus pneumoniae Serotypes Associated with Death, South Africa, 2012–2018

Annelies MüllerComments to Author , Jackie Kleynhans, Linda de Gouveia, Susan Meiring, Cheryl Cohen, Lucy Jane Hathaway1, Anne von Gottberg1, and for GERMS-SA
Author affiliations: University of Bern Graduate School for Cellular and Biomedical Sciences, Bern, Switzerland (A. Müller); University of Bern Institute for Infectious Diseases, Bern (A. Müller, L.J. Hathaway); National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa (J. Kleynhans, L. de Gouveia, S. Meiring, C. Cohen, A. von Gottberg); University of the Witwatersrand, Johannesburg (J. Kleynhans, S. Meiring, C. Cohen, A. von Gottberg); These authors contributed equally to this article.1

Main Article

Table 4

Multivariable analysis of factors associated with in-hospital death among patients >15 years of age with invasive pneumococcal disease, South Africa, 2012–2018

Risk factor
 No. deaths/total no. (%)
 Unadjusted OR (95% CI)
 p value
 Adjusted OR (95% CI)
 p value
Serotype
4 64/208 (30.8) 0.9 (0.6–1.2) 0.406 1.1 (0.7–1.8) 0.541
6B 14/34 (41.2) 1.3 (0.7–2.8) 0.415 1.6 (0.7–1) 0.296
9V 7/31 (22.6) 0.6 (0.2–1.3) 0.194 0.6 (0.2–1.8) 0.344
14 20/54 (37.0) 1.1 (0.6–2.1) 0.681 1.5 (0.8–3) 0.236
18C 13/37 (35.1) 1 (0.5–2.1) 0.907 0.7 (0.3–1.9) 0.524
19F 47/109 (43.1) 1.5 (0.9–2.3) 0.091 1.5 (0.9–2.5) 0.154
23F 31/79 (39.2) 1.2 (0.8–2.1) 0.395 1.6 (0.9–2.9) 0.127
1 87/202 (43.1) 1.5 (1–2.1) 0.038 1.7 (1.1–2.7) 0.017
3 88/251 (35.1) 1 (0.7–1.5) 0.823 1.1 (0.8–1.7) 0.524
5 7/14 (50.0) 1.9 (0.7–5.6) 0.230 2.3 (0.7–7.8) 0.180
6A 42/87 (48.3) 1.8 (1.1–2.9) 0.015 1.6 (0.9–2.8) 0.127
7F 23/79 (29.1) 0.8 (0.5–1.3) 0.388 1 (0.5–1.8) 0.885
19A 97/306 (31.7) 0.9 (0.6–1.2) 0.499 1.3 (0.9–2) 0.176
2 1/2 (50.0) 1.9 (0.1–31.1) 0.644 4.5 (0.3–74.4) 0.288
8 121/354 (34.2) Referent Referent Referent Referent
9N 34/112 (30.4) 0.8 (0.5–1.3) 0.454 1.3 (0.8–2.3) 0.307
10A 35/84 (41.7) 1.4 (0.8–2.2) 0.199 1.5 (0.8–2.6) 0.185
11A 12/34 (35.3) 1.1 (0.5–2.2) 0.896 0.9 (0.3–2.7) 0.881
12F 97/307 (31.6) 0.9 (0.6–1.2) 0.481 0.8 (0.5–1.2) 0.250
15B/C 38/80 (47.5) 1.7 (1.1–2.8) 0.027 2.1 (1.2–3.7) 0.010
17F 23/87 (26.4) 0.7 (0.4–1.2) 0.169 0.7 (0.4–1.3) 0.250
20 2/13 (15.4) 0.4 (0.1–1.6) 0.177 0.3 (0–2.8) 0.309
22F 39/99 (39.4) 1.3 (0.8–2) 0.338 1.3 (0.7–2.2) 0.413
33F 3/11 (27.3) 0.7 (0.2–2.8) 0.635 0.8 (0.2–3.9) 0.781
16F 52/121 (43.0) 1.5 (1–2.2) 0.083 1.6 (1–2.7) 0.066
15A 42/104 (40.1) 1.3 (0.8–2) 0.246 1.2 (0.6–2) 0.629
13 19/71 (26.8) 0.7 (0.4–1.2) 0.226 0.8 (0.4–1.6) 0.534
7C 20/59 (33.9) 1 (0.6–1.8) 0.966 1.4 (0.7–2.7) 0.342
35B 19/52 (36.5) 1.1 (0.6–2) 0.738 1 (0.5–2.1) 0.922
23A 19/62 (30.7) 0.9 (0.5–1.5) 0.587 0.6 (0.3–1.2) 0.141
6C
 11/34 (32.4)
 0.9 (0.4–2)
 0.830
 0.8 (0.3–2)
 0.590
Age group, y
15–24 86/282 (30.5) Referent Referent Referent Referent
25–44 549/1,738 (31.6) 1.1 (0.8–1.4) 0.714 1.2 (0.8–1.7) 0.392
45–64 385/917 (42.0) 1.6 (1.2–2.2) 0.001 2 (1.4–2.9) <0.001
>65
 107/240 (44.6)
 1.8 (1.3–2.6)
 0.001
 3.1 (1.8–5.2)
 <0.001
Sex
F 557/1,679 (33.2) Referent Referent Referent Referent
M
 568/1,495 (38.0)
 1.2 (1.1–1.4)
 0.005
 1.3 (1.1–1.6)
 0.003
HIV status†
Negative 154/556 (27.7) Referent Referent Referent Referent
Positive
 618/2,007 (30.8)
 1.2 (0.9–1.4)
 0.160
 1.3 (1–1.7)
 0.021
Diagnosis‡
Nonmeningitis 607/2,138 (28.4) Referent Referent Referent Referent
Meningitis
 520/1,039 (50.1)
 2.5 (2.2–2.9)
 <0.001
 2.8 (2.3–3.4)
 <0.001
Year
2012 205/555 (36.9) 1.4 (1.1–1.8) 0.013 1.1 (0.8–1.5) 0.549
2013 144/486 (29.6) Referent Referent Referent Referent
2014 143/407 (35.1) 1.3 (1–1) 0.08 1.1 (0.8–1.5) 0.626
2015 177/465 (38.1) 1.5 (1.1–1.9) 0.006 1.4 (1.0–2.0) 0.031
2016 168/449 (37.4) 1.4 (1.1–1.9) 0.012 1.3 (0.9–1.8) 0.106
2017 159/447 (35.6) 1.3 (1–1.7) 0.053 1.3 (0.9–1.8) 0.140
2018
 131/368 (35.6)
 1.3 (1–1.8)
 0.065
 1.4 (1.0–1.9)
 0.082
Province
Eastern Cape 77/217 (35.5) 0.8 (0.5–1.3) 0.406
Free State 55/138 (39.9) Referent Referent
Gauteng 410/1,219 (33.6) 0.8 (0.5–1.1) 0.145
KwaZulu–Natal 176/505 (34.9) 0.8 (0.5–1.2) 0.278
Limpopo 29/56 (51.8) 1.6 (0.9–3) 0.130
Mpumalanga 65/139 (46.8) 1.3 (0.8–2.1) 0.246
Northern Cape 63/178 (35.4) 0.8 (0.5–1.3) 0.416
North West 42/93 (45.2) 1.2 (0.7–2.1) 0.423
Western Cape 210/632 (33.2) 0.8 (0.5–1.1) 0.138

*Underlying medical conditions as a risk factor was analyzed but not significant in the univariate model. Empty fields indicate that the model did not calculate numbers due to small amount of data, or it was not included in the final multivariable model. Factors evaluated in the univariable model but not significant were race and province. †HIV status was not significant upon initial multivariate analysis but was kept in the final analysis because of the high percentage of HIV positive cases in our study population (78%). ‡Meningitis cases include patients diagnosed with meningitis and those simultaneously diagnosed with meningitis and lower respiratory tract infection; nonmeningitis cases include all other cases.

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Page created: December 13, 2021
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