Flamaing J, Verhaegen J, Peetermans W E
Department of Geriatric Medicine, Department of Microbiology, Department of General Internal Medicine, University Hospital Leuven, Leuven, Belgium.
J Antimicrob Chemother. 2002 Jul;50(1):43-50. doi: 10.1093/jac/dkf086.
The characteristics of bacteraemia with Streptococcus pneumoniae in children (0-4 years) and the elderly (> or =60 years) were compared over a 7 year period (1994-2000). Of a total of 7927 isolates of invasive S. pneumoniae studied in the national reference laboratory, 74% (n = 5837) were blood isolates. Of these 5837 S. pneumoniae bacteraemias, 843 (14%) occurred in children and 3144 (54%) in the elderly. The prevalence of penicillin resistance (MIC > or = 0.1 mg/L) in bacteraemic isolates rose from 8.2% to 18.9% (P = 0.03) in children and from 5.1% to 16.35% (P = 0.001) in the elderly over the study period. The prevalence of erythromycin resistance (MIC > or= 1 mg/L) in bacteraemic isolates was significantly higher in children than in the elderly (44.7% versus 25.7%, P = 0.001) and rose significantly over the 7 year period in the elderly (18.6-33.65%, P = 0.001). There were more serogroups and serotypes (SGTs) among the bacteraemic isolates obtained from the elderly compared with children (36 versus 26, P = 0.03). SGTs 6, 14, 18 and 19 cause significantly more bacteraemia in children than in the elderly. The opposite is true for SGTs 3, 7, 8, 9, 11, 12, 15, 20, 22 and 35. The new 7, 9 and 11 valent conjugate vaccine formulations cover significantly more bacteraemic SGTs in children than in the elderly (82%, 89.5% and 92% versus 55.5%, 65% and 77.5%, respectively; P = 0.001). The 23 valent polysaccharide vaccine provides a theoretical coverage of 95% in the elderly population. Our data indicate consideration of a vaccination strategy in the elderly population that combines the efficacy of conjugate vaccines with the broad coverage of the 23 valent polysaccharide vaccine.
对1994年至2000年这7年间0至4岁儿童和60岁及以上老年人肺炎链球菌菌血症的特征进行了比较。在国家参考实验室研究的7927株侵袭性肺炎链球菌分离株中，74%（n = 5837）为血液分离株。在这5837例肺炎链球菌菌血症中，843例（14%）发生在儿童中，3144例（54%）发生在老年人中。在研究期间，菌血症分离株中青霉素耐药（MIC≥0.1mg/L）的发生率在儿童中从8.2%升至18.9%（P = 0.03），在老年人中从5.1%升至16.35%（P = 0.001）。菌血症分离株中红霉素耐药（MIC≥1mg/L）的发生率在儿童中显著高于老年人（44.7%对25.7%，P = 0.001），且在老年人中7年间显著上升（18.6% - 33.65%，P = 0.001）。与儿童相比，从老年人中获得的菌血症分离株中的血清群和血清型（SGTs）更多（36种对26种，P = 0.03）。血清群6、14、18和19在儿童中引起的菌血症明显多于老年人。血清群3、7、8、9、11、12、15、20、22和35则相反。新的7价、9价和11价结合疫苗制剂在儿童中覆盖的菌血症SGTs明显多于老年人（分别为82%、89.5%和92%对55.5%、65%和77.5%；P = 0.001）。23价多糖疫苗在老年人群体中的理论覆盖率为95%。我们的数据表明，对于老年人群体的疫苗接种策略，应考虑将结合疫苗的有效性与23价多糖疫苗的广泛覆盖相结合。
