用结合疫苗预防抗生素耐药性肺炎链球菌。

Prevention of antibiotic-nonsusceptible Streptococcus pneumoniae with conjugate vaccines.

机构信息

Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia 30329, USA.

出版信息

J Infect Dis. 2012 Feb 1;205(3):401-11. doi: 10.1093/infdis/jir755. Epub 2011 Dec 7.

DOI:10.1093/infdis/jir755

PMID:22158567

Abstract

BACKGROUND

Streptococcus pneumoniae (pneumococcus) caused approximately 44000 US invasive pneumococcal disease (IPD) cases in 2008. Antibiotic nonsusceptibility complicates IPD treatment. Using penicillin susceptibility breakpoints adopted in 2008, we evaluated antibiotic-nonsusceptible IPD trends in light of the introductions of a 7-valent pneumococcal conjugate vaccine (PCV7) in 2000 and a 13-valent pneumococcal conjugate vaccine (PCV13) in 2010.

METHODS

IPD cases were defined by isolation of pneumococcus from a normally sterile site in individuals residing in Active Bacterial Core surveillance (ABCs) areas during 1998-2008. Pneumococci were serotyped and tested for antibiotic susceptibility using broth microdilution.

RESULTS

During 1998-2008, ABCs identified 43198 IPD cases. Penicillin-nonsusceptible strains caused 6%-14% of IPD cases, depending on age. Between 1998-1999 and 2008, penicillin-nonsusceptible IPD rates declined 64% for children aged <5 years (12.1-4.4 cases per 100000), and 45% for adults aged ≥65 (4.8-2.6 cases per 100000). Rates of IPD nonsusceptible to multiple antibiotics mirrored these trends. During 2007-2008, serotypes in PCV13 but not PCV7 caused 78%-97% of penicillin-nonsusceptible IPD, depending on age.

CONCLUSIONS

Antibiotic-nonsusceptible IPD rates remain below pre-PCV7 rates for children <5 and adults ≥65 years old. PCV13 vaccines hold promise for further nonsusceptibility reductions.

摘要

背景

2008 年，肺炎链球菌（肺炎球菌）导致美国约 44000 例侵袭性肺炎球菌病（IPD）病例。抗生素耐药性使 IPD 治疗变得复杂。使用 2008 年采用的青霉素药敏折点，我们根据 2000 年 7 价肺炎球菌结合疫苗（PCV7）和 2010 年 13 价肺炎球菌结合疫苗（PCV13）的引入，评估了抗生素耐药性 IPD 的趋势。

方法

通过从居住在主动细菌核心监测（ABCs）区域的个体正常无菌部位分离肺炎球菌，定义 IPD 病例。使用肉汤微量稀释法对肺炎球菌进行血清分型和抗生素药敏试验。

结果

1998-2008 年期间，ABCs 共发现 43198 例 IPD 病例。青霉素不敏感株引起的 IPD 病例占 6%-14%，取决于年龄。1998-1999 年至 2008 年，5 岁以下儿童青霉素不敏感 IPD 发病率下降 64%（每 10 万人中 12.1-4.4 例），65 岁以上成人下降 45%（每 10 万人中 4.8-2.6 例）。对多种抗生素不敏感的 IPD 发病率与这些趋势相符。2007-2008 年，PCV13 而非 PCV7 引起的血清型占青霉素不敏感 IPD 的 78%-97%，取决于年龄。