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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 3

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 4/15 (26.7) 1.2 (0.4–4.1) 0.740 2.2 (0.6–8.1) 0.231
6B 3/30 (10.0) 0.4 (0.1–1.3) 0.124 0.6 (0.2–2.4) 0.492
14 4/23 (17.4) 0.7 (0.2–2.2) 0.556 1.2 (0.4–3.9) 0.777
18C 4/11 (36.4) 1.9 (0,5–7) 0.317 3.1 (0.8–12.2) 0.104
19F 23/69 (33.3) 1.7 (0.9–3.2) 0.102 3.5 (1.7–7.1) <0.001
23F 12/57 (21.1) 0.9 (0.4–1.9) 0.778 1.9 (0.9–4.4) 0.108
1 4/80 (5.0) 0.2 (0.1–0.5) 0.002 0.6 (0.2–1.8) 0.328
3 10/39 (25.6) 1.2 (0.5–2.6) 0.716 2.1 (0.8–5) 0.115
5 1/14 (7.1) 0.3 (0–2.1) 0.201 0.3 (0–2.1) 0.200
6A 12/34 (35.3) 1.8 (0.8–4.1) 0.135 3.2 (1.4–7.5) 0.008
19A 12/73 (16.4) 0.7 (0.3–1.4) 0.267 1.2 (0.5–2.6) 0.646
8 35/153 (22.9) Referent Referent Referent Referent
9N 3/15 (20.0) 0.8 (0.2–3.2) 0.800 1.5 (0.4–6) 0.583
10A 13/37 (35.1) 1.8 (0.8–4) 0.127 2.8 (1.2–6.5) 0.015
11A 9/14 (64.3) 6.1 (1.9–19.3) 0.002 11.1 (3.3–37.8) <0.001
12F 9/68 (13.2) 0.5 (0.2–1.1) 0.102 0.8 (0.3–1.8) 0.545
15B/C 10/66 (15.2) 0.6 (0.3–1.3) 0.197 1 (0.5–2.3) 0.941
17F 6/26 (23.1) 1 (0.4–2.7) 0.982 1.8 (0.6–5.2) 0.260
20 1/6 (16.7) 0.7 (0.1–6) 0.723 0.9 (0.1–8.8) 0.940
22F 6/12 (50.0) 3.4 (1–11.1) 0.046 5 (1.4–18.1) 0.015
16F 12/57 (21.1) 0.9 (0.4–1.9) 0.778 1.5 (0.7–3.3) 0.317
15A 18/50 (36.0) 1.9 (1–3.8) 0.069 3.3 (1.6–6.9) 0.002
13 8/20 (40.0) 2.2 (0.9–5.9) 0.102 4.3 (1.5–12) 0.006
7C 3/27 (11.1) 0.4 (0.1–1.5) 0.178 0.5 (0.1–1.8) 0.293
35B 14/53 (26.4) 1.2 (0.6–2.5) 0.602 1.8 (0.8–3.8) 0.148
23A 4/18 (22.2) 1 (0.3–3.1) 0.950 2 (0.6–6.7) 0.277
6C
 2/10 (20.0)
 0.8 (0.2–4.2)
 0.834
 1.6 (0.3–8.6)
 0.579
Age group, y
<1 152/504 (30.2) 3.5 (2.3–5.3) <0.001 3.1 (1.9–5.1) <0.001
1–4 60/319 (18.8) 1.9 (1.2–3) 0.009 1.6 (0.9–2.6) 0.086
5–14
 30/272 (11.0)
 Referent
 Referent
 Referent
 Referent
Sex
F 124/505 (24.6) Referent Referent Referent Referent
M
 117/588 (20.0)
 0.8 (0.6–1)
 0.065
 0.7 (0.5–1)
 0.055
HIV status
Negative 111/587 (18.9) Referent Referent
Positive
 66/318 (20.8)
 1.1 (0.8–1.6)
 0.504
Diagnosis†
Nonmeningitis 129/695 (18.6) Referent Referent Referent Referent
Meningitis
 113/400 (28.3)
 1.7 (1.3–2.3)
 <0.001
 1.8 (1.3–2.6)
 <0.001
Year‡
2012 40/237 (16.9) Referent Referent
2013 45/193 (23.3) 1.5 (0.9–2.4) 0.097
2014 38/194 (19.6) 1.2 (0.7–2) 0.468
2015 33/138 (23.9) 1.5 (0.9–2.6) 0.098
2016 39/136 (28.7) 2 (1.2–3.3) 0.008
2017 25/106 (23.6) 1.5 (0.9–2.7) 0.145
2018
 22/91 (24.2)
 1.6 (0.9–2.8)
 0.133
Province
Eastern Cape 19/55 (34.6) 4.3 (1.8–10.5) 0.001 3.9 (1.5–10.1) 0.004
Free State 9/83 (10.8) Referent Referent Referent Referent
Gauteng 97/417 (23.3) 2.5 (1.2–5.2) 0.014 2.3 (1.1–5) 0.031
KwaZulu–Natal 30/180 (16.7) 1.6 (0.7–3.6) 0.220 1.7 (0.7–3.8) 0.243
Limpopo 3/20 (15.0) 1.5 (0.4–5.9) 0.605 1.1 (0.3–4.9) 0.855
Mpumalanga 5/33 (15.2) 1.5 (0.5–4.8) 0.522 1.2 (0.4–4.3) 0.724
Northern Cape 10/36 (27.8) 3.2 (1.2–8.6) 0.025 3.8 (1.3–11.2) 0.014
North West 9/26 (34.6) 4.4 (1.5–12.6) 0.007 3.3 (1.1–10.6) 0.040
Western Cape 60/245 (24.5) 2.7 (1.3–5.6) 0.010 2 (0.9–4.5) 0.085

*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 included HIV status, race and underlying medical conditions. Serotypes 7F, 9V and 33F did not have any fatal cases and serotype 2 was not detected. †Meningitis cases include patients diagnosed with meningitis and those with concurrent meningitis and lower respiratory tract infection; nonmeningitis cases include all other IPD cases. ‡The risk factor "year" was significant upon univariate but not multivariate analysis and therefore dropped for the final model.

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Page created: December 13, 2021
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