Servicio de Microbiología-Instituto Biodonostia, Hospital Donostia, Paseo Dr. Beguiristain s/n, 20014 San Sebastián, Spain.
Antimicrob Agents Chemother. 2011 Jun;55(6):2729-34. doi: 10.1128/AAC.01546-10. Epub 2011 Mar 14.
In the elderly, Streptococcus pneumoniae is the most common cause of pneumonia and one of the most frequently isolated pathogens in cases of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). This study was conducted to compare the pneumococcal isolates obtained during episodes of AECOPD and pneumonia in patients of ≥65 years old and to analyze whether in patients with AECOPD and pneumonia within a short interval, the same isolate caused both episodes. This laboratory-based study was performed between 2005 and 2008. Pneumococcal isolates from episodes of pneumonia (n = 401) and AECOPD (n = 398), matched one-to-one by date of isolation, were characterized. The serotypes and genotypes of other pneumococcal isolates causing pneumonia and AECOPD in the same patient were compared. In patients with pneumonia, COPD as an underlying disease was not associated with more-drug-resistant pneumococci. In contrast, isolates causing AECOPD showed higher rates of resistance than those causing pneumonia. Serotypes 1, 3, and 7F were more frequent in pneumonia. The same pneumococcus was involved in 25.7% (9/35 patients) of patients with two consecutive AECOPD episodes but in only 6.3% (2/32 patients) of COPD patients with pneumonia and exacerbation (Fisher's exact test; P = 0.047). Less invasive serotypes were isolated more often in AECOPD and were more resistant to antimicrobials. The presence of a specific pneumococcal serotype in AECOPD does not predict the etiology of subsequent pneumonia.
在老年人中，肺炎链球菌是导致肺炎的最常见原因，也是慢性阻塞性肺疾病急性加重（AECOPD）病例中最常分离出的病原体之一。本研究旨在比较≥65 岁 AECOPD 和肺炎患者中分离出的肺炎链球菌，并分析在 AECOPD 和肺炎在短时间内发作的患者中，是否为同一分离株引起了这两种疾病。该基于实验室的研究于 2005 年至 2008 年进行。对肺炎（n=401）和 AECOPD（n=398）发作期间分离出的肺炎链球菌进行了特征分析，并按分离日期进行了一对一的匹配。对同一患者引起肺炎和 AECOPD 的其他肺炎链球菌分离株的血清型和基因型进行了比较。在肺炎患者中，COPD 作为潜在疾病与更多耐药肺炎球菌无关。相比之下，引起 AECOPD 的分离株比引起肺炎的分离株具有更高的耐药率。血清型 1、3 和 7F 在肺炎中更为常见。在 35 例连续两次发生 AECOPD 的患者中，有 25.7%（9/35 例）的患者涉及同一种肺炎球菌，而在因肺炎和加重而发生 AECOPD 的 32 例 COPD 患者中仅为 6.3%（2/32 例）（Fisher 确切检验；P=0.047）。在 AECOPD 中分离出的侵袭性较小的血清型更常对抗生素产生耐药性。AECOPD 中特定肺炎球菌血清型的存在并不能预测随后肺炎的病因。
