Frontiers in cellular and infection microbiology · 2026
Hidden burden of pneumococcal colonization in adults with viral respiratory infections: the role of influenza and RSV.
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España-Bonilla Rocío, Calvo-Silveria Sara, González-Díaz Aida, Guevara-Figueras Júlia, Fernández-Delgado Lucía, Medina-Gómez Catalina, Calatayud Laura, Niubó Jordi, Gasa Mercè, Abelenda-Alonso Gabriela, Domínguez M Ángeles, Peñafiel Judith, Ardanuy Carmen, Càmara Jordi
Аннотация
INTRODUCTION: Although pneumococcal colonization is uncommon in adults, it may increase during respiratory viral infections. We investigated the frequency of pneumococcal colonization, associated factors, and serotype distribution in adults with confirmed respiratory viral infection.
METHODS: We prospectively included adults presenting to the Emergency Department of Bellvitge University Hospital with influenza A virus (IAV), SARS-CoV-2, or respiratory syncytial virus (RSV) infection, as well as 33 virus-negative controls (December 2023-January 2024). Nasopharyngeal swabs were tested for Streptococcus pneumoniae using a RT-PCR assay (lytA and piaB genes). Clinical data were analysed using Cox proportional hazards regression models.
RESULTS: A total of 616 episodes were studied (IAV, n=391; SARS-CoV-2, n=162; RSV, n=28; >1 virus, n=35). Pneumococcal colonization was detected in 85 individuals, with the highest prevalence among IAV-infected patients (14.8%), followed by RSV (10.7%) and SARS-CoV-2 (9.3%). Individuals with viral infection showed higher pneumococcal loads (median lytA CT 23.1 [18.7-27.4]) compared to those without infection (CT 31.8 [31.5-33.3]). IAV (OR 3.52; 95%CI 1.30-9.17) and RSV (OR 4.04; 95%CI 1.11-13.50) were independently associated with pneumococcal colonization. Among adults <65 years, female sex (OR for male sex 0.43; 95% CI 0.19-0.90) was associated with colonization, whereas in those ≥65 years, RSV infection (OR 5.56; 95% CI 1.03-27.31) was the main association. Detected serotypes were diverse, predominantly non-PCV serotypes.
CONCLUSIONS: Pneumococcal colonization was more frequent during IAV or RSV than SARS-CoV-2 infection. In older adults, RSV infection showed a particularly strong association, highlighting potential implications for pneumococcal and RSV vaccination strategies.
METHODS: We prospectively included adults presenting to the Emergency Department of Bellvitge University Hospital with influenza A virus (IAV), SARS-CoV-2, or respiratory syncytial virus (RSV) infection, as well as 33 virus-negative controls (December 2023-January 2024). Nasopharyngeal swabs were tested for Streptococcus pneumoniae using a RT-PCR assay (lytA and piaB genes). Clinical data were analysed using Cox proportional hazards regression models.
RESULTS: A total of 616 episodes were studied (IAV, n=391; SARS-CoV-2, n=162; RSV, n=28; >1 virus, n=35). Pneumococcal colonization was detected in 85 individuals, with the highest prevalence among IAV-infected patients (14.8%), followed by RSV (10.7%) and SARS-CoV-2 (9.3%). Individuals with viral infection showed higher pneumococcal loads (median lytA CT 23.1 [18.7-27.4]) compared to those without infection (CT 31.8 [31.5-33.3]). IAV (OR 3.52; 95%CI 1.30-9.17) and RSV (OR 4.04; 95%CI 1.11-13.50) were independently associated with pneumococcal colonization. Among adults <65 years, female sex (OR for male sex 0.43; 95% CI 0.19-0.90) was associated with colonization, whereas in those ≥65 years, RSV infection (OR 5.56; 95% CI 1.03-27.31) was the main association. Detected serotypes were diverse, predominantly non-PCV serotypes.
CONCLUSIONS: Pneumococcal colonization was more frequent during IAV or RSV than SARS-CoV-2 infection. In older adults, RSV infection showed a particularly strong association, highlighting potential implications for pneumococcal and RSV vaccination strategies.