Infectious Diseases Department, St Louis Hospital, Assistance-Publique-Hôpitaux de Paris (APHP), 1, Avenue Claude Vellefaux, 75010, Paris, France.
Infection. 2013 Jun;41(3):663-8. doi: 10.1007/s15010-013-0419-x. Epub 2013 Feb 13.
Invasive pneumococcal diseases (IPD) remain frequent and severe events in human immunodeficiency virus (HIV)-infected subjects despite the use of antiretroviral therapy and the availability of vaccines. Our aim was to assess the antibiotic susceptibilities and serotypes of strains responsible for IPD in HIV-infected patients.
We retrospectively analyzed all Streptococcus pneumoniae strains isolated from normally sterile sites between 2000 and 2011 in HIV-infected patients from a single reference center in Paris. The minimum inhibitory concentrations were determined by the E-test, and serotyping was performed by the antiserum agglutination method.
Among our study group, 41 HIV-infected adults presented 43 IPD during the study period. Of these 41 patients, 78 % were men, and the median age was 43 (range 23-62) years. the median CD4 cell count was 184/mm(3) (6-1,090/mm(3)), 51 % were receiving antiretroviral therapy, and 24 % had plasma HIV-RNA levels of <400 copies/mL. Only two patients had received the pneumococcal polysaccharide 23-valent vaccine (PPV23). Isolates were susceptible to penicillin G, amoxicillin, and cotrimoxazole in 44, 70, and 59 % of cases, respectively, and were significantly less susceptible to these antibiotics than isolates in the French general population during the same period. Among the 27 strains serotyped, 18 different serotypes were observed, of which 19A, 14, 7F, and 6A were the most frequent. Serotype distribution was similar to that in the French general population. The PPV23 vaccine and the 13-valent conjugate vaccine (PCV13) would have theoretically covered 78 and 70 % of cases, respectively.
In our HIV-infected patient cohort, S. pneumoniae isolates demonstrated higher levels of resistance to beta-lactamines and cotrimoxazole than in the French general population. HIV-infected patients should benefit from the herd protection effect expected from the large-scale vaccination of children by PCV13.
尽管已有抗逆转录病毒疗法和疫苗可用，侵袭性肺炎球菌病（IPD）在人类免疫缺陷病毒（HIV）感染者中仍是常见且严重的疾病。我们的目的是评估引起 HIV 感染者 IPD 的菌株的抗生素敏感性和血清型。
我们回顾性分析了 2000 年至 2011 年间，来自巴黎一个参考中心的 HIV 感染者无菌部位分离出的所有肺炎链球菌株。最小抑菌浓度通过 E 试验确定，血清型通过抗血清凝集法确定。
在我们的研究组中，41 名 HIV 感染的成年人在研究期间出现了 43 例 IPD。这些患者中，78%为男性，中位年龄为 43（23-62）岁。中位 CD4 细胞计数为 184/mm3（6-1090/mm3），51%正在接受抗逆转录病毒治疗，24%的患者血浆 HIV-RNA 水平<400 拷贝/mL。仅有 2 例患者接受了肺炎球菌多糖 23 价疫苗（PPV23）。分离株对青霉素 G、阿莫西林和复方磺胺甲噁唑的敏感性分别为 44%、70%和 59%，与同期法国普通人群的分离株相比，这些抗生素的敏感性明显较低。在 27 株血清型鉴定的菌株中，观察到 18 种不同的血清型，其中 19A、14、7F 和 6A 最为常见。血清型分布与法国普通人群相似。PPV23 疫苗和 13 价结合疫苗（PCV13）理论上分别可覆盖 78%和 70%的病例。
在我们的 HIV 感染患者队列中，肺炎链球菌分离株对β-内酰胺类和复方磺胺甲噁唑的耐药性水平高于法国普通人群。HIV 感染者应受益于 PCV13 对儿童进行大规模接种所带来的群体保护效应。
