健康成年人中的侵袭性肺炎球菌病：与克隆型瑞典（1）-ST306 相关的脓胸增加。
Invasive pneumococcal disease in healthy adults: increase of empyema associated with the clonal-type Sweden(1)-ST306.
机构信息
Infectious Disease Department, Hospital Bellvitge, Idibell, Ciberes, University of Barcelona, Barcelona, Spain.
出版信息
PLoS One. 2012;7(8):e42595. doi: 10.1371/journal.pone.0042595. Epub 2012 Aug 13.
BACKGROUND
Adult invasive pneumococcal disease (IPD) occurs mainly in the elderly and patients with co-morbidities. Little is known about the clinical characteristics, serotypes and genotypes causing IPD in healthy adults.
METHODS
We studied 745 culture-proven cases of IPD in adult patients aged 18-64 years (1996-2010). Patients were included in two groups: 1.) adults with co-morbidities, and 2.) healthy adults, who had no prior or coincident diagnosis of a chronic or immunosuppressive underlying disease. Microbiological studies included pneumococcal serotyping and genotyping.
RESULTS
Of 745 IPD episodes, 525 (70%) occurred in patients with co-morbidities and 220 (30%) in healthy adults. The healthy adults with IPD were often smokers (56%) or alcohol abusers (18%). As compared to patients with co-morbidities, the healthy adults had (P<0.05): younger age (43.5+/-13.1 vs. 48.7+/-11.3 years); higher proportions of women (45% vs. 24%), pneumonia with empyema (15% vs. 7%) and infection with non-PCV7 serotypes including serotypes 1 (25% vs. 5%), 7F (13% vs. 4%), and 5 (7% vs. 2%); and lower mortality (5% vs. 20%). Empyema was more frequently caused by serotype 1. No death occurred among 79 patients with serotype 1 IPD. There was an emergence of virulent clonal-types Sweden(1)-ST306 and Netherlands(7F)-ST191. The vaccine serotype coverage with the PCV13 was higher in healthy adults than in patients with co-morbidities: 82% and 56%, respectively, P<0.001.
CONCLUSION
In this clinical study, one-third of adults with IPD had no underlying chronic or immunosuppressive diseases (healthy adults). They were often smokers and alcohol abusers, and frequently presents with pneumonia and empyema caused by virulent clones of non-PCV7 serotypes such as the Sweden(1)-ST306. Thus, implementing tobacco and alcohol abuse-cessation measures and a proper pneumococcal vaccination, such as PCV13 policy, in active smokers and alcohol abusers may diminish the burden of IPD in adults.
背景
成人侵袭性肺炎球菌病（IPD）主要发生在老年人和合并症患者中。对于健康成年人中导致 IPD 的临床特征、血清型和基因型知之甚少。
方法
我们研究了 1996 年至 2010 年间 745 例经培养证实的 18-64 岁成人 IPD 患者。将患者分为两组：1.合并症患者；2.健康成年人，无慢性或免疫抑制性基础疾病的既往或并存诊断。微生物学研究包括肺炎球菌血清型和基因型分析。
结果
745 例 IPD 发作中，525 例（70%）发生在合并症患者中，220 例（30%）发生在健康成年人中。健康成年人 IPD 患者多为吸烟者（56%）或酗酒者（18%）。与合并症患者相比，健康成年人（P<0.05）：年龄较小（43.5±13.1 岁 vs. 48.7±11.3 岁）；女性比例较高（45% vs. 24%）、肺炎合并脓胸（15% vs. 7%）、感染非 PCV7 血清型，包括血清型 1（25% vs. 5%）、7F（13% vs. 4%）和 5（7% vs. 2%）；死亡率较低（5% vs. 20%）。脓胸更常由血清型 1 引起。79 例血清型 1 IPD 患者无死亡。出现了毒力克隆型瑞典（1）-ST306 和荷兰（7F）-ST191。健康成年人的 PCV13 疫苗血清型覆盖率高于合并症患者：分别为 82%和 56%，P<0.001。
结论
在这项临床研究中，三分之一的 IPD 成人无潜在的慢性或免疫抑制性疾病（健康成年人）。他们多为吸烟者和酗酒者，常因非 PCV7 血清型（如瑞典（1）-ST306）的毒力克隆引起肺炎和脓胸。因此，在吸烟者和酗酒者中实施戒烟和戒酒措施以及适当的肺炎球菌疫苗接种（如 PCV13 政策）可能会降低成人 IPD 的负担。
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