Departments of Pediatrics of Baylor College of Medicine, Houston, Texas.
Ohio State University College of Medicine, Columbus.
Clin Infect Dis. 2017 Jun 15;64(12):1699-1704. doi: 10.1093/cid/cix115.
BACKGROUND.: The impact of PCV13 on a number of clinical aspects of pneumococcal pneumonia (PP) in children has not been reported. We compared the serotype distribution, antibiotic susceptibility, and outcomes of children with PP 4 years before and 4 years after the introduction of PCV13.
METHODS.: We identified patients ≤18 years with PP at 8 children's hospitals in the United States (2006-2014). Pneumococcal isolates were collected prospectively. Serotyping and antibiotic susceptibility were performed in a central laboratory. Clinical and laboratory data were collected retrospectively. Annual pneumococcal pneumonia hospitalization rates per 100 000 admissions with 95% confidence intervals were calculated. Dichotomous variables were analyzed by χ2 test and continuous variables with Mann-Whitney U test.
RESULTS.: A total of 377 patients with PP requiring hospitalization were identified. Hospitalization rates of PP decreased from 53.6 to 23.3 per 100000 admissions post PCV13 (P < .0001). Complicated PP rates also decreased (P < .0001). Need for intensive care, mechanical ventilation, and invasive procedure remained unchanged after the introduction of PCV13. Comorbidities were more common among children with uncomplicated than complicated pneumonia (52.2% vs. 22.5%, P < .001). Overall, PCV13 serotypes 19A, 3, 7F, and 1 caused 80% of PP. Hospitalization rates of PCV13 serotype pneumonia decreased from 47.2 to 15.7 per 100000 admissions post PCV13. In 2014, the most common serotypes were 3, 19A and 35B.
CONCLUSIONS.: PP requiring hospitalization significantly decreased in children after PCV13 introduction. Complicated PP rates decreased steadily in 2011-2014. PCV13 serotypes 19A and 3 were still responsible for half of the cases of PP in 2011-2014.
PCV13 对儿童肺炎链球菌性肺炎（PP）的许多临床方面的影响尚未得到报道。我们比较了 PCV13 引入前后 4 年儿童 PP 的血清型分布、抗生素敏感性和结局。
我们在美国 8 家儿童医院确定了≤18 岁的 PP 患者（2006-2014 年）。前瞻性收集肺炎球菌分离株。在中央实验室进行血清分型和抗生素敏感性检测。回顾性收集临床和实验室数据。计算每 100000 次入院的肺炎球菌性肺炎住院率及其 95%置信区间。采用 χ2 检验分析二项变量，采用 Mann-Whitney U 检验分析连续变量。
共确定 377 例需要住院治疗的 PP 患者。PCV13 后，PP 的住院率从 53.6 降至 23.3/100000 入院（P <.0001）。复杂 PP 的发生率也降低（P <.0001）。PCV13 引入后，需要重症监护、机械通气和侵入性操作的病例数保持不变。无并发症肺炎患儿的合并症比复杂肺炎患儿更常见（52.2%比 22.5%，P <.001）。总体而言，PCV13 血清型 19A、3、7F 和 1 引起 80%的 PP。PCV13 血清型肺炎的住院率从 PCV13 后的 47.2 降至 15.7/100000 入院。2014 年，最常见的血清型是 3、19A 和 35B。
PCV13 引入后，儿童需要住院治疗的 PP 显著减少。复杂 PP 的发生率在 2011-2014 年稳步下降。2011-2014 年，PCV13 血清型 19A 和 3 仍占 PP 病例的一半。
