Trends in Streptococcus pneumoniae serotypes and antimicrobial resistance in Italy (2007–2023): A mixed-effects model analysis of invasive pneumococcal disease

IF 4.8 3区医学 Q1 INFECTIOUS DISEASES

Journal of Infection and Public Health Pub Date : 2026-03-01 Epub Date: 2026-01-09 DOI:10.1016/j.jiph.2026.103145

Irene Amoruso , Marco Fonzo , Simone Agostini , Francesca Russo , Vincenzo Baldo , Tatjana Baldovin , Chiara Bertoncello

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引用次数: 0

Abstract

Introduction

Invasive pneumococcal disease (IPD) remains a significant public health concern despite the widespread implementation of pneumococcal conjugate vaccines (PCVs). Shifts in serotype distribution and antimicrobial resistance (AMR) patterns, particularly in the post-PCV13 era, necessitate ongoing surveillance to inform vaccine and treatment policies.

Methods

We conducted a retrospective analysis of laboratory-confirmed IPD cases reported in the Veneto Region of north-eastern Italy between 2007 and 2023. Data were obtained from regional surveillance systems and included serotype, clinical presentation, demographics, and antimicrobial susceptibility. Trends in IPD incidence were modelled using negative binomial generalised linear mixed models (GLMM). Serotype distribution and AMR patterns were examined over time and in relation to age, sex, and clinical syndrome.

Results

A total of 59 pneumococcal serotypes were identified. Serotype 3 was most frequent, followed by 8 and 19 A. Significant increases were observed for serotype 8, while vaccine-included serotypes (e.g., 6 A, 23 F, 7 F) declined. AMR remained stable overall, with erythromycin and clindamycin resistance observed in 17.3 % and 13.2 % of isolates, respectively. Resistance was concentrated in serotypes 14, 15 A, and 19 A. Serotype 8 showed high prevalence but low resistance rates. The overall IPD incidence remained stable; however, a modest upward trend was observed in pre-COVID19 pandemic years.

Conclusion

Our findings highlight the evolving pneumococcal landscape in the post-PCV13 era, with emerging serotypes contributing significantly to IPD burden. The observed serotype-specific AMR patterns underscore the importance of integrated surveillance to support regionally tailored immunisation strategies and empirical therapy choices. Expanded-valency vaccines may offer broader protection against emerging serotypes.

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意大利肺炎链球菌血清型和抗菌素耐药性趋势（2007-2023）：侵袭性肺炎球菌疾病的混合效应模型分析

尽管肺炎球菌结合疫苗（pcv）得到广泛应用，但侵袭性肺炎球菌病（IPD）仍然是一个重大的公共卫生问题。血清型分布和抗菌素耐药性（AMR）模式的变化，特别是在pcv13后时代，需要持续监测，以便为疫苗和治疗政策提供信息。方法回顾性分析意大利东北部威尼托地区2007 - 2023年报告的IPD实验室确诊病例。数据来自区域监测系统，包括血清型、临床表现、人口统计学和抗菌药物敏感性。IPD发病率趋势采用负二项广义线性混合模型（GLMM）建模。血清型分布和AMR模式随时间的推移以及与年龄、性别和临床综合征的关系进行了检查。结果共检出59种肺炎球菌血清型。血清3型发病最多，其次为8例和19例 A。血清8型显著增加，而包含疫苗的血清型（例如6 A、23 F、7 F）下降。抗菌素耐药性总体保持稳定，对红霉素和克林霉素的耐药性分别为17.3% %和13.2 %。耐药集中在14、15 A和19 A血清型。血清8型患病率高，但耐药率低。总体IPD发病率保持稳定；然而，在2019冠状病毒病大流行前的年份，出现了小幅上升趋势。结论：我们的研究结果强调了后pcv13时代肺炎球菌格局的演变，新出现的血清型对IPD负担有重要影响。观察到的血清型特异性抗菌素耐药性模式强调了综合监测的重要性，以支持区域量身定制的免疫策略和经验性治疗选择。扩展价疫苗可能对新出现的血清型提供更广泛的保护。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Infection and Public Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -INFECTIOUS DISEASES

CiteScore

13.10

自引率

1.50%

发文量

203

审稿时长

96 days

期刊介绍： The Journal of Infection and Public Health, first official journal of the Saudi Arabian Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences and the Saudi Association for Public Health, aims to be the foremost scientific, peer-reviewed journal encompassing infection prevention and control, microbiology, infectious diseases, public health and the application of healthcare epidemiology to the evaluation of health outcomes. The point of view of the journal is that infection and public health are closely intertwined and that advances in one area will have positive consequences on the other. The journal will be useful to all health professionals who are partners in the management of patients with communicable diseases, keeping them up to date. The journal is proud to have an international and diverse editorial board that will assist and facilitate the publication of articles that reflect a global view on infection control and public health, as well as emphasizing our focus on supporting the needs of public health practitioners. It is our aim to improve healthcare by reducing risk of infection and related adverse outcomes by critical review, selection, and dissemination of new and relevant information in the field of infection control, public health and infectious diseases in all healthcare settings and the community.