Bueno Campaña M, Agúndez Reigosa B, Jimeno Ruiz S, Echávarri Olavarría F, Martínez Granero M A
Area de Pediatría y Neonatología, Fundación Hospital Alcorcón, Madrid, Spain.
An Pediatr (Barc). 2008 Feb;68(2):92-8. doi: 10.1157/13116221.
Streptococcus pneumoniae is the microorganism most frequently associated with complicated pleural effusion. After the introduction of the heptavalent pneumococcal vaccine, there was a decline in the incidence of invasive pneumococcal disease and, to a lesser extent, in that of pneumonia. However, the incidence of empyema apparently increased. The antipneumococcal heptavalent vaccine was introduced in Spain in 2001.
To determine whether the incidence of pleural effusion secondary to pneumonia has increased in hospitalized patients and to examine the possible influence of the antipneumococcal heptavalent vaccine on the incidence rate of parapneumonic effusions.
Patients aged less than 16 years old admitted to our hospital with a diagnosis of pneumonia between 1999 and 2005 were retrospectively reviewed. We calculated the annual incidence rate of pleural effusion with respect to the total number of patients admitted with pneumonia and with respect to patients considered to have probable bacterial pneumonia, based on previously established criteria.
A total of 337 patients were analyzed, of which 213 (63.2%) met the criteria for a diagnosis of probable bacterial pneumonia. Pleural effusion was found in 34 patients (15.9%), and 13 of these effusions (38%) were complicated. No clear trend was detected in the annual incidence of probable bacterial pneumonia per 100 admitted patients, although the highest numbers were detected in the last two years of the study period. The percentage of complications (effusions) remained constant (mean: 16.28%). No differences were found in the effusion rate between vaccinated and unvaccinated patients (12.5% vs 18.6%).
The trend in the incidence of parapneumonic pleural effusions was parallel and proportional to that of probable bacterial pneumonia.
肺炎链球菌是与复杂性胸腔积液最常相关的微生物。在引入七价肺炎球菌疫苗后，侵袭性肺炎球菌疾病的发病率有所下降，肺炎发病率也有一定程度下降。然而，脓胸的发病率显然有所上升。七价抗肺炎球菌疫苗于2001年在西班牙引入。
确定住院患者中肺炎继发胸腔积液的发病率是否增加，并研究七价抗肺炎球菌疫苗对类肺炎性胸腔积液发病率的可能影响。
回顾性分析1999年至2005年期间我院收治的诊断为肺炎的16岁以下患者。根据先前确定的标准，我们计算了胸腔积液相对于肺炎住院患者总数以及被认为可能患有细菌性肺炎患者的年发病率。
共分析了337例患者，其中213例（63.2%）符合可能细菌性肺炎的诊断标准。34例患者（15.9%）发现有胸腔积液，其中13例（38%）为复杂性胸腔积液。每100例入院患者中可能细菌性肺炎的年发病率未发现明显趋势，尽管在研究期的最后两年发病率最高。并发症（胸腔积液）的百分比保持不变（平均：16.28%）。接种疫苗和未接种疫苗的患者在胸腔积液发生率上未发现差异（12.5%对18.6%）。
类肺炎性胸腔积液的发病率趋势与可能细菌性肺炎的趋势平行且成比例。
