Infectious Disease Department, Hospital Universitari Vall d'Hebron, Autonomous University of Barcelona, P Vall d'Hebron 119-129, Barcelona 08035, Spain.
HIV Med. 2009 Jul;10(6):356-63. doi: 10.1111/j.1468-1293.2009.00695.x. Epub 2009 Mar 11.
Recent studies in hospitalized patients with community-acquired pneumonia have found a lower risk of bacteraemia and better clinical outcomes in patients who had previously received the 23-valent pneumococcal polysaccharide vaccine (PPV) in comparison with unvaccinated individuals. The aim of this study was to assess the influence of prior PPV on clinical outcomes in HIV-infected adult patients hospitalized with invasive pneumococcal disease (IPD).
This was an observational study of all consecutive HIV-infected adults hospitalized with IPD from January 1996 to October 2007 in three hospitals in Spain. Baseline characteristics and clinical outcome-related variables were compared according to prior PPV vaccination status.
A total of 162 episodes of IPD were studied. In 23 of these (14.2%), patients had previously received PPV. In both vaccinated and unvaccinated patients, most of the causal serotypes were included in the 23-valent PPV (76.9% and 84.1%, respectively). Overall, 25 patients (15.4%) died during hospitalization, 21 patients (13%) required admission to an intensive care unit (ICU) and 34 patients (21%) reached the composite outcome of death and/or admission to the ICU. None of the 23 patients who had previously received PPV died or required ICU admission, in comparison with 25 (18%; P=0.026) and 21 (15.1%; P=0.046), respectively, of the unvaccinated patients. The length of hospital stay for vaccinated patients was significantly shorter (8.48 vs. 13.27 days; P=0.011).
Although 23-valent PPV failed to prevent IPD in some HIV-infected patients, vaccination produced beneficial effects on clinical outcomes by decreasing illness severity and mortality related to IPD.
最近对社区获得性肺炎住院患者的研究发现，与未接种疫苗的患者相比，先前接受过 23 价肺炎球菌多糖疫苗（PPV）的患者发生菌血症的风险较低，临床结局更好。本研究旨在评估先前接受 PPV 对感染人类免疫缺陷病毒（HIV）的成年患者因侵袭性肺炎球菌病（IPD）住院的临床结局的影响。
这是一项在西班牙三家医院对 1996 年 1 月至 2007 年 10 月期间因 IPD 住院的所有连续 HIV 感染成年患者进行的观察性研究。根据先前接受 PPV 疫苗接种情况比较了基线特征和与临床结局相关的变量。
共研究了 162 例 IPD 发作。其中 23 例（14.2%）患者先前接受过 PPV。在接种疫苗和未接种疫苗的患者中，大多数致病血清型均包含在 23 价 PPV 中（分别为 76.9%和 84.1%）。总体而言，25 例（15.4%）患者在住院期间死亡，21 例（13%）需要入住重症监护病房（ICU），34 例（21%）达到死亡和/或入住 ICU 的复合结局。与未接种疫苗的患者相比，先前接受过 PPV 的 23 例患者中无一人死亡或需要入住 ICU，分别为 25 例（18%；P=0.026）和 21 例（15.1%；P=0.046）。接种疫苗患者的住院时间明显缩短（8.48 天 vs. 13.27 天；P=0.011）。
尽管 23 价 PPV 未能预防某些 HIV 感染患者的 IPD，但通过降低与 IPD 相关的疾病严重程度和死亡率，疫苗接种对临床结局产生了有益影响。
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