School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Pediatr Infect Dis J. 2011 Dec;30(12):1075-80. doi: 10.1097/INF.0b013e31822cca05.
Pneumococcal disease is a major global cause of morbidity and mortality. This study evaluated risk factors for mortality in children with pneumococcal meningitis and other invasive pneumococcal diseases (IPD).
The study population included patients <15 years of age with laboratory-confirmed IPD and available outcome data between January 1, 2003 and December 31, 2005 as reported to a national laboratory-based surveillance program. Meningitis was defined by having pneumococcus identified from cerebrospinal fluid culture, while other IPD included patients with pneumococci identified from other normally sterile site specimens. Risk factors for mortality were evaluated using multivariable logistic regression.
A total of 2251 patients with IPD were reported from sentinel sites: 581 with laboratory-confirmed meningitis and 1670 with other IPD. The case-fatality ratio was 35% (205/581) among meningitis cases and 18% (300/1670) among other IPD cases (P < 0.001). Among individuals with available human immunodeficiency virus (HIV) status data, HIV coinfection was less likely among patients with meningitis compared with other IPD (74% [244/328] vs. 82% [880/1067] P < 0.001). On multivariable analysis, HIV-infected status (odds ratio [OR]: 5.34, 95% confidence interval [CI]: 2.32-12.29), Pitt bacteremia score ≥4 (OR: 3.08, 95% CI: 1.21-7.83) and age group <1 year (OR: 2.58, 95% CI: 1.21-5.51) were independent predictors of death among patients with meningitis. Among children with other IPD, malnutrition was an independent predictor of death while HIV infection was not independently associated with increased risk of death.
Pneumococcal meningitis is associated with a high case-fatality ratio among South African children and this is increased by HIV coinfection. Increasing access to antiretroviral therapy and a catch-up program for pneumococcal conjugate vaccine among HIV-infected and malnourished children could reduce this excess mortality.
肺炎球菌疾病是导致发病率和死亡率的一个主要全球性原因。本研究评估了儿童患肺炎球菌性脑膜炎和其他侵袭性肺炎球菌病（IPD）的死亡风险因素。
该研究人群包括 2003 年 1 月 1 日至 2005 年 12 月 31 日期间向全国基于实验室的监测计划报告的实验室确诊 IPD 且可获得结局数据的＜15 岁患者。脑膜炎的定义为从脑脊液培养中检出肺炎球菌，而其他 IPD 包括从其他正常无菌部位标本中检出肺炎球菌的患者。使用多变量逻辑回归评估死亡风险因素。
从哨点报告了 2251 例 IPD 患者：581 例实验室确诊脑膜炎，1670 例其他 IPD。脑膜炎病例的病死率为 35%（205/581），其他 IPD 病例为 18%（300/1670）（P＜0.001）。在有可用人类免疫缺陷病毒（HIV）状态数据的个体中，与其他 IPD 相比，HIV 合并感染在脑膜炎患者中不太可能发生（74%[244/328]比 82%[880/1067]，P＜0.001）。多变量分析显示，HIV 感染状态（比值比[OR]：5.34，95%置信区间[CI]：2.32-12.29）、Pitt 菌血症评分≥4（OR：3.08，95%CI：1.21-7.83）和年龄＜1 岁（OR：2.58，95%CI：1.21-5.51）是脑膜炎患者死亡的独立预测因素。在患有其他 IPD 的儿童中，营养不良是死亡的独立预测因素，而 HIV 感染与死亡风险增加无关。
南非儿童患肺炎球菌性脑膜炎的病死率较高，HIV 合并感染会增加病死率。增加 HIV 感染和营养不良儿童的抗逆转录病毒治疗机会和肺炎球菌结合疫苗的追赶计划可降低这种过高的死亡率。
