确定 肺炎链球菌 对澳大利亚社区获得性肺炎的贡献。

Determining the contribution of Streptococcus pneumoniae to community-acquired pneumonia in Australia.

机构信息

National Centre for Immunisation Research and Surveillance, Kids Research Institute, Children's Hospital at Westmead, Sydney, NSW

National Centre for Immunisation Research and Surveillance, Kids Research Institute, Children's Hospital at Westmead, Sydney, NSW.

出版信息

Med J Aust. 2017 Nov 6;207(9):396-400. doi: 10.5694/mja16.01102.

DOI:10.5694/mja16.01102

PMID:29092707

Abstract

OBJECTIVE

To evaluate trends in the proportion and severity of community-acquired pneumonia (CAP) attributable to Streptococcus pneumoniae (pneumococcus) in Australians aged 18 years and over.

STUDY DESIGN

Systematic review with unpublished data from the largest study.

DATA SOURCES

Multiple key bibliographic databases to June 2016.

STUDY SELECTION

Australian studies on the aetiology of CAP in adults.

DATA SYNTHESIS

In the 12 studies identified, pneumococcus was the most common cause of CAP. Four studies were assessed as being of good quality. Participants in two studies were predominantly non-Indigenous (n = 991); the proportion of pneumococcal CAP cases declined from 26.4% in 1987-88 to 13.9% in 2004-06, and the proportion with bacteraemia decreased from 7.8% to 3.8%. In two studies with predominantly Indigenous participants (n = 252), the proportion with pneumococcal bacteraemia declined from 6.8% in 1999-2000 to 4.2% in 2006-07. In the largest study (n = 885; 2004-06), 50.8% (60/118) of pneumococcal CAP occurred in people who were ≥ 65 years old. Among patients aged ≥ 65 years, intensive care unit admission and death were more common in patients who were ≥ 85 years old compared with younger patients (12.5% v 6.8%; 18.8% v 6.8% respectively), and also more common in the 19 patients with bacteraemia than in those without it (15.8% v 2.6%; 10.5% v 7.9% respectively). Of 17 cases of bacteraemia serotyped, 12 were due to 13-valent pneumococcal conjugate vaccine (13vPCV) serotypes and three to additional serotypes in 23-valent pneumococcal polysaccharide vaccine (23vPPV).

CONCLUSIONS

Available data suggest that the proportion of CAP attributable to pneumococcus (both bacteraemic and non-bacteraemic) has been declining in Australian adults. Should 13vPCV replace the 23vPPV currently funded by the National Immunisation Program for persons aged ≥ 65 years, surveillance to track non-bacteraemic pneumococcal CAP will be essential to evaluate the impact.

摘要

目的

评估澳大利亚 18 岁及以上人群社区获得性肺炎（CAP）中肺炎链球菌（肺炎球菌）所致比例和严重程度的变化趋势。

研究设计

系统评价并结合最大研究的未发表数据。

数据来源

截至 2016 年 6 月的多个主要文献数据库。

研究选择

澳大利亚成年人 CAP 病因学的研究。

数据综合

在确定的 12 项研究中，肺炎球菌是 CAP 的最常见病因。四项研究被评为质量良好。两项研究的参与者主要是非土著人（n = 991）；肺炎球菌 CAP 病例的比例从 1987-88 年的 26.4%下降到 2004-06 年的 13.9%，菌血症的比例从 7.8%下降到 3.8%。在两项主要参与者为土著人的研究（n = 252）中，肺炎球菌菌血症的比例从 1999-2000 年的 6.8%下降到 2006-07 年的 4.2%。在最大的研究（n = 885；2004-06 年）中，118 例肺炎球菌 CAP 中有 50.8%（60/118）发生在≥65 岁的人群中。在≥65 岁的患者中，与年轻患者相比，≥85 岁的患者中 ICU 入院和死亡更为常见（12.5%比 6.8%；18.8%比 6.8%），并且在 19 例菌血症患者中也比无菌血症患者更为常见（15.8%比 2.6%；10.5%比 7.9%）。在 17 例菌血症患者中，12 例为 13 价肺炎球菌结合疫苗（13vPCV）血清型，3 例为 23 价肺炎球菌多糖疫苗（23vPPV）中其他血清型。