Pérez A, Sala P, Giménez M, Sierra M, Esteve A, Alonso A, Quesada M, Raspall F, Ausina V, Rodrigo C
Servicio de Microbiología, Hospital Germans Trias i Pujol, Carretera del Canyet s/n, Badalona, Barcelona, Spain.
Eur J Clin Microbiol Infect Dis. 2004 Sep;23(9):677-81. doi: 10.1007/s10096-004-1197-2. Epub 2004 Aug 18.
In this study, 90 episodes of pneumococcal bacteremia that occurred over an 8-year period in two hospitals in Barcelona were analyzed retrospectively to determine the clinical and bacteriological characteristics of pneumococcal bacteremia, the risk factors for antibiotic resistance, the outcome, and the vaccine coverage. The mean age of the patients was 3.1 years and the male/female ratio was 1.7. The overall rates of penicillin-non-susceptible, cefotaxime-non-susceptible, and erythromycin-resistant isolates were 48.8, 24.4, and 25.5%, respectively. Antibiotic resistance was associated with children under the age of 2 years and with previous antibiotic treatment. The percentage of antibiotic resistance was higher in the nine episodes that occurred in patients with an underlying illness. The most prevalent serotypes identified were 1, 14, 6B, 18C, 5, and 19A. Serotypes 6A/B, 14, and 19A/F were isolated primarily from children under 2, whereas serotypes 1 and 5 were recovered more frequently from older children. Apparent relationships between serotypes 6A/B, 14, and 19A/F and occult bacteremia and between serotypes 1 and 5 and bacteremic pneumonia were confounded by the age variable. The proportion of bacteremic episodes preventable by all (7-valent, 9-valent, and 11-valent) of the conjugate pneumococcal vaccines was 60% in children under 2. In older children, the serotype coverage rate for the three formulations was 48, 87, and 87%, respectively. In summary, these data expand upon previous Spanish studies in which serotypes 1 and 5 were reported to be among the leading causes of severe systemic pneumococcal infections in children over 2, findings that should be taken into consideration when planning vaccine programmes.
在本研究中，对巴塞罗那两家医院8年间发生的90例肺炎球菌菌血症病例进行了回顾性分析，以确定肺炎球菌菌血症的临床和细菌学特征、抗生素耐药危险因素、转归及疫苗覆盖率。患者的平均年龄为3.1岁，男女比例为1.7。青霉素不敏感、头孢噻肟不敏感及红霉素耐药菌株的总体发生率分别为48.8%、24.4%和25.5%。抗生素耐药与2岁以下儿童及既往抗生素治疗有关。在有基础疾病患者发生的9例病例中，抗生素耐药百分比更高。鉴定出的最常见血清型为1、14、6B、18C、5和19A。6A/B、14和19A/F血清型主要从2岁以下儿童中分离得到，而1和5血清型在年龄较大儿童中更常分离到。6A/B、14和19A/F血清型与隐匿性菌血症之间以及1和5血清型与菌血症性肺炎之间的明显关系因年龄变量而混淆。在2岁以下儿童中，所有（7价、9价和11价）结合肺炎球菌疫苗可预防的菌血症发作比例为60%。在年龄较大儿童中，三种制剂的血清型覆盖率分别为48%、87%和87%。总之，这些数据扩展了先前西班牙的研究，其中报告1和5血清型是2岁以上儿童严重全身性肺炎球菌感染的主要原因之一，这些发现应在规划疫苗计划时予以考虑。
