Department of Pediatrics.
Department of Data Science, University of Mississippi Medical Center, Jackson, Mississippi.
Pediatr Infect Dis J. 2019 Mar;38(3):241-247. doi: 10.1097/INF.0000000000002119.
Although the epidemiology of immunocompromising condition in children has evolved over time, updated epidemiology of pediatric pneumocystis infection in the United States is not available.
We performed a retrospective analysis using the Kids' Inpatient Database, a nationally representative sample of US pediatric hospital discharges collected in 1997, 2000, 2003, 2006, 2009 and 2012. Pneumocystis cases were identified using International Classification of Diseases, Ninth Revision, Clinical Modification, code 136.3 among children 0-18 years of age. Demographic data of cases with and without mortality were compared.
We identified 1902 [standard error (SE): 95] pneumocystis cases during the study period. The pneumocystis hospitalization rate decreased from 7.5 (SE: 0.91) to 2.7 (SE: 0.31) per a million US children from 1997 to 2012 (63.2% decrease). Cases with HIV infection decreased from 285 (SE: 56) cases in 1997 to 29 (SE: 7) cases in 2012, whereas hematologic malignancy and primary immunodeficiency became more prominent. Infants were the most commonly affected [510 cases (SE: 40)]. All-cause in-hospital mortality was 11.7% (SE: 1.3%) and was particularly high among cases with hematopoietic stem cell transplant [32.4%(SE: 7.1%); P < 0.001].
Pneumocystis infection in children showed a marked decrease from 1997 to 2012 in the United States, largely driven by the reduction in HIV-associated cases, and cases with non-HIV illnesses became more prominent. Hematopoietic stem cell transplant-associated cases had particularly high mortality. Clinicians should be aware of high-risk groups that may benefit from chemoprophylaxis, particularly in infancy.
尽管儿童免疫抑制状况的流行病学随时间发生了变化，但目前仍缺乏美国儿科肺孢子菌感染的最新流行病学资料。
我们使用 Kids' Inpatient Database（美国儿童住院患者的全国代表性样本）进行了一项回顾性分析，该数据库的数据采集时间为 1997 年、2000 年、2003 年、2006 年、2009 年和 2012 年。0-18 岁儿童的肺孢子菌感染病例通过国际疾病分类第 9 版临床修订版（ICD-9-CM）代码 136.3 进行识别。对比了有死亡病例和无死亡病例的患者的人口统计学数据。
研究期间共发现 1902 例（标准误差（SE）：95）肺孢子菌感染病例。从 1997 年到 2012 年，肺孢子菌的住院率从每百万美国儿童 7.5（SE：0.91）例降至 2.7（SE：0.31）例（下降 63.2%）。感染人类免疫缺陷病毒（HIV）的病例从 1997 年的 285 例（SE：56）降至 2012 年的 29 例（SE：7），而血液系统恶性肿瘤和原发性免疫缺陷病的病例则更为常见。婴儿是最常受影响的人群[510 例（SE：40）]。所有病因的院内死亡率为 11.7%（SE：1.3%），造血干细胞移植病例的死亡率特别高[32.4%（SE：7.1%）；P < 0.001]。
1997 年至 2012 年期间，美国儿童的肺孢子菌感染显著减少，这主要归因于与 HIV 相关的病例减少，而非 HIV 相关的病例更为突出。与造血干细胞移植相关的病例死亡率特别高。临床医生应了解高危人群，特别是在婴儿期，这些人群可能从化学预防中获益。
