Carriage of Streptococcus pneumoniae in asymptomatic, community-dwelling elderly in the Netherlands

Colonization of the upper respiratory tract by Streptococcus pneumoniae is considered prerequisite for pneumococcal disease. Despite high rates of pneumococcal disease in elderly, pneumococcal carriage rates are usually below 5% when detected by the conventional culture method. We assessed pneumococcal carriage in 330 asymptomatic community-dwelling elderly aged 65 years and older. While pneumococci were cultured from 25 (8%) individuals, 65 (20%) elderly were positive for the pneumococcus-specific lytA gene when tested by quantitative-PCR, increasing the overall number of carriers to 75 (22%). Significantly more oropharyngeal samples were pneumococci-positive (18% versus 10%, p<0.001) when tested by the molecular method as compared to nasopharyngeal samples. Our findings indicate that pneumococcal carriage in elderly is higher than previously reported with up to 1 in 5 asymptomatic community-dwelling elderly positive for pneumococcal carriage, when detected by qPCR. The detection of pneumococci by conventional culture alone, greatly underestimates S. pneumoniae colonization in elderly.