Gessner B D
Association Pour l'Aide à la Médecine Préventive, Institut Pasteur, Paris, France.
Eur J Clin Microbiol Infect Dis. 2002 Feb;21(2):79-87. doi: 10.1007/s10096-001-0667-z.
Some areas of the world are known to have a low incidence of Haemophilus influenzae type b meningitis, although the reasons for this are unknown. Furthermore, no complete evaluation of the worldwide variation in the incidence of Haemophilus influenzae type b meningitis has been published. In the current study, the published medical literature was reviewed to identify all studies conducted in the absence of routine childhood Haemophilus influenzae type b conjugate vaccination that reported an incidence of Haemophilus influenzae type b meningitis among children less than 5 years of age. To test the hypothesis that antibiotic use may have influenced the incidence of meningitis, incidence rates were correlated with antibiotic resistance. Seventy-one articles reported an incidence of childhood Haemophilus influenzae type b meningitis (median, 21 cases per 100,000 population per year; range, 1-95 cases per 100,000 population per year), with Asia and central/southern Europe reporting lower incidences than other areas (median, 5 and 11 cases per 100,000 per year, respectively). Within these regions of low incidence, the proportion of cerebrospinal fluid specimens that had a leukocyte count or glucose or protein level suggestive of bacterial meningitis but from which no organism was identified was low, indicating that there was no large reservoir of Haemophilus influenzae type b meningitis that went undetected by the laboratory. Study-specific incidence rates of meningitis correlated with the proportion of isolates resistant to ampicillin (or producing beta-lactamase) (R2=0.35. P=0.0014). The incidence of Haemophilus influenzae type b meningitis is substantially lower in some areas of the world than others, but this difference is unlikely to be related primarily to laboratory methodology. In contrast, antibiotic use may contribute to the observed differences in incidence.
世界上一些地区已知b型流感嗜血杆菌脑膜炎发病率较低，但其原因尚不清楚。此外，尚未发表关于b型流感嗜血杆菌脑膜炎发病率全球差异的完整评估。在本研究中，对已发表的医学文献进行了综述，以确定所有在未进行常规儿童b型流感嗜血杆菌结合疫苗接种的情况下开展的研究，这些研究报告了5岁以下儿童b型流感嗜血杆菌脑膜炎的发病率。为了检验抗生素使用可能影响脑膜炎发病率这一假设，将发病率与抗生素耐药性进行了关联分析。71篇文章报告了儿童b型流感嗜血杆菌脑膜炎的发病率（中位数为每年每10万人口21例；范围为每年每10万人口1 - 95例），亚洲和欧洲中部/南部报告的发病率低于其他地区（中位数分别为每年每10万人口5例和11例）。在这些低发病率地区，脑脊液标本中白细胞计数、葡萄糖或蛋白质水平提示细菌性脑膜炎但未鉴定出病原体的比例较低，这表明不存在大量未被实验室检测到的b型流感嗜血杆菌脑膜炎传染源。特定研究的脑膜炎发病率与对氨苄西林耐药（或产生β - 内酰胺酶）的分离株比例相关（R2 = 0.35，P = 0.0014）。世界上一些地区的b型流感嗜血杆菌脑膜炎发病率明显低于其他地区，但这种差异不太可能主要与实验室方法有关。相比之下，抗生素使用可能是观察到的发病率差异的原因之一。
