南非儿童胸腔积脓的病因及发病率
Etiology and Incidence of Pleural Empyema in South African Children.
作者信息
Zampoli Marco, Kappos Alexia, Wolter Nicole, von Gottberg Anne, Verwey Charl, Mamathuba Rendani, Zar Heather J
机构信息
From the *Division of Pediatric Pulmonology, Department of Pediatrics and Child Health, University of Cape Town, Cape Town, South Africa; †Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; ‡Department of Pediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa; and §MRC Unit on Child & Adolescent Health, Cape Town, South Africa.
出版信息
Pediatr Infect Dis J. 2015 Dec;34(12):1305-10. doi: 10.1097/INF.0000000000000880.
BACKGROUND
South Africa introduced the 7-valent pneumococcal conjugate vaccine (PCV7) in 2009 and PCV13 in 2011. The etiology and incidence of childhood empyema in an 8-year period overlapping the introduction of PCV was investigated.
METHODS
Children younger than 12 years admitted with empyema at a tertiary pediatric hospital in Cape Town, South Africa, from December 2006 to December 2011 (cohort A) and January 2012 to December 2014 (cohort B) were investigated. Pathogens were identified by culture of pleural fluid and blood. In addition, polymerase chain reaction targeting bacterial pathogens and Streptococcus pneumoniae serotypes was conducted on pleural fluid in a subset of patients enrolled 2009-2011.
RESULTS
Cohort A: 142 children were prospectively enrolled, with a median age of 17 months (interquartile range 8-43). Most (92%) children were unimmunized with PCV. S. pneumoniae and Staphylococcus aureus were the most common culture-identified pathogens (each 25 of 142; 18%); polymerase chain reaction of pleural fluid increased yield of S. pneumoniae detection by 31% [26 of 54 (48%) vs. 9 of 54 (17%), P < 0.001]. Serotypes were identified for 24 of 26 (92%) patients with S. pneumoniae, of which 22 of 24 (92%) were included in PCV13. Cohort B: 22 patients were retrospectively identified. No pathogen was found in 12 of 22 (54.5%) patients and S. pneumoniae in 1 patient (4.5%). Empyema incidence declined by 50% in cohort B compared with that of cohort A (4.2 vs. 10.4 cases per 1000 pneumonia admissions; risk ratio: 0.5; 95% confidence incidence: 0.3-0.7).
CONCLUSION
S. pneumoniae is the commonest cause of childhood empyema in South Africa. PCV has been highly effective at reducing empyema incidence in South African children.
背景
南非于2009年引入7价肺炎球菌结合疫苗（PCV7），并于2011年引入PCV13。对在引入PCV期间的8年里儿童脓胸的病因及发病率进行了调查。
方法
对2006年12月至2011年12月（队列A）以及2012年1月至2014年12月（队列B）期间在南非开普敦一家三级儿科医院因脓胸入院的12岁以下儿童进行调查。通过胸腔积液和血液培养鉴定病原体。此外，对2009 - 2011年入组的部分患者的胸腔积液进行针对细菌病原体和肺炎链球菌血清型的聚合酶链反应。
结果
队列A：前瞻性纳入142名儿童，中位年龄为17个月（四分位间距8 - 43）。大多数（92%）儿童未接种PCV。肺炎链球菌和金黄色葡萄球菌是培养鉴定出的最常见病原体（各占142例中的25例；18%）；胸腔积液的聚合酶链反应使肺炎链球菌检测率提高了31%[54例中的26例（48%）对54例中的9例（17%），P < 0.001]。在26例肺炎链球菌患者中的24例（92%）鉴定出了血清型，其中24例中的22例（92%）包含在PCV13中。队列B：回顾性鉴定出22例患者。22例患者中的12例（54.5%）未发现病原体；1例患者（4.5%）发现肺炎链球菌。与队列A相比，队列B中脓胸发病率下降了50%（每1000例肺炎入院病例中分别为4.2例和10.4例；风险比：0.5；95%置信区间：0.3 - 0.7）。
结论
肺炎链球菌是南非儿童脓胸最常见的病因。PCV在降低南非儿童脓胸发病率方面非常有效。
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