南亚肺炎球菌联盟网络观察到的尼泊尔坎蒂儿童医院的侵袭性肺炎球菌疾病。

Invasive pneumococcal disease in Kanti Children's Hospital, Nepal, as observed by the South Asian Pneumococcal Alliance network.

作者信息

Shah A S, Knoll M Deloria, Sharma P R, Moisi J C, Kulkarni P, Lalitha M K, Steinhoff M, Thomas K

机构信息

Institute of Medicine and Kanti Children's Hospital, Kathmandu, Nepal.

出版信息

Clin Infect Dis. 2009 Mar 1;48 Suppl 2:S123-8. doi: 10.1086/596490.

DOI:10.1086/596490

PMID:19191607

Abstract

BACKGROUND

Pneumonia accounts for approximately 2 million deaths annually among children aged <5 years, with most of these deaths occurring in Africa and southern Asia. The South Asian Pneumococcal Alliance (SAPNA) network in Nepal is generating local epidemiological data to assist in the development of national and regional policies for prevention of pneumococcal and Haemophilus influenzae (Hib) disease.

METHODS

Children aged 2 months to 5 years with suspected invasive bacterial disease were recruited from Kanti Children Hospital, Kathmandu, Nepal. Specimens of blood, CSF, and normally sterile body fluids were cultured, and analysis of antimicrobial susceptibility patterns and serotyping of Streptococcus pneumoniae isolates were performed. CSF specimens were also tested for S. pneumoniae and Hib antigens by a latex agglutination test and an immunochromatographic test of pneumococcal antigen (NOW S. pneumoniae Antigen Test; Binax).

RESULTS

A total of 2528 children with suspected invasive bacterial disease were recruited, of whom 82% had pneumonia, 9.6% had meningitis, 2% had very severe disease, and 0.4% had bacteremia; the remainder received another diagnosis. Before hospitalization, 26.7% had received antibiotic treatment. Fifty children had S. pneumoniae identified as the etiological agent of invasive disease. Of 2461 blood cultures performed, 22 were positive for S. pneumoniae. Of 33 cases of S. pneumoniae meningitis, 11 were detected by CSF culture, and 21 were detected by latex agglutination and pneumococcal antigen tests. The rate of detection of S. pneumoniae in CSF was 3.6% by culture, compared with 7.8% by latex agglutination and 10% by pneumococcal antigen testing. The rate of detection of H. influenzae in CSF was 1.7% by culture and 6.5% by latex agglutination. The most common serotypes found were 1, 5, 2, and 7F, followed by 12A, 19B, and 23F. Of all the invasive isolates, 3.8% were resistant to penicillin, and 68% were resistant to trimethoprim-sulfamethoxazole.

CONCLUSIONS

The SAPNA network has identified Hib and pneumococci as causes of significant disease in Nepal.

摘要

背景

肺炎每年导致约200万5岁以下儿童死亡，其中大多数死亡发生在非洲和南亚。尼泊尔的南亚肺炎球菌联盟（SAPNA）网络正在收集当地的流行病学数据，以协助制定国家和地区预防肺炎球菌及B型流感嗜血杆菌（Hib）疾病的政策。

方法

从尼泊尔加德满都的坎蒂儿童医院招募2个月至5岁疑似侵袭性细菌病的儿童。对血液、脑脊液和通常无菌的体液样本进行培养，并对肺炎链球菌分离株进行抗菌药敏模式分析和血清分型。脑脊液样本还通过乳胶凝集试验和肺炎球菌抗原免疫层析试验（NOW肺炎球菌抗原检测；Binax）检测肺炎链球菌和Hib抗原。

结果

共招募了2528名疑似侵袭性细菌病的儿童，其中82%患有肺炎，9.6%患有脑膜炎，2%患有极严重疾病，0.4%患有菌血症；其余儿童得到了其他诊断。住院前，26.7%的儿童接受过抗生素治疗。50名儿童的侵袭性疾病病因被确定为肺炎链球菌。在进行的2461次血培养中，22次肺炎链球菌呈阳性。在33例肺炎链球菌脑膜炎病例中，11例通过脑脊液培养检测到，21例通过乳胶凝集试验和肺炎球菌抗原检测检测到。脑脊液中肺炎链球菌的培养检出率为3.6%，乳胶凝集试验为7.8%，肺炎球菌抗原检测为10%。脑脊液中流感嗜血杆菌的培养检出率为1.7%，乳胶凝集试验为6.5%。最常见的血清型为1、5、2和7F，其次是12A、19B和23F。在所有侵袭性分离株中，3.8%对青霉素耐药，68%对甲氧苄啶-磺胺甲恶唑耐药。