Department of Infectious Diseases, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1100 AZ, Amsterdam, The Netherlands.
Department of Infectious Diseases, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1100 AZ, Amsterdam, The Netherlands; Clinical Division of Infection and Tropical Medicine, Medical University of Vienna, Splitalgasse 23, 1090, Vienna, Austria.
Travel Med Infect Dis. 2018 Jul-Aug;24:89-100. doi: 10.1016/j.tmaid.2018.05.016. Epub 2018 Jun 1.
Invasive pneumococcal disease (IPD) is associated with high morbidity and mortality, with immunocompromised patients (ICPs) at particular risk. Therefore, guidelines recommend pneumococcal vaccination for these patients. However, guidelines are scarcely underpinned with references to incidence studies of IPD in this population. This, potentially results in unawareness of the importance of vaccination and low vaccination rates. The objective of this systematic review and meta-analysis was to assess the incidence of IPD in ICPs.
We systematically searched PubMed and Embase to identify studies in English published before December 6th, 2017 that included terms related to 'incidence', 'rate', 'pneumococcal', 'pneumoniae', 'meningitis', 'septicemia', or 'bacteremia'. We focused on patients with HIV, transplantation and chronic inflammatory diseases.
We included 45 studies in the systematic review reporting an incidence or rate of IPD, defined as isolation of Streptococcus pneumoniae from a normally sterile site. Random effects meta-analysis of 38 studies showed a pooled IPD incidence of 331/100,000 person years in patients with HIV in the late-antiretroviral treatment era in non-African countries, and 318/100,000 in African countries; 696 and 812/100,000 in patients who underwent an autologous or allogeneic stem cell transplantation, respectively; 465/100,000 in patients with a solid organ transplantation; and 65/100,000 in patients with chronic inflammatory diseases. In healthy control cohorts, the pooled incidence was 10/100,000.
ICPs are at increased risk of contracting IPD, especially those with HIV, and those who underwent transplantation. Based on our findings, we recommend pneumococcal vaccination in immunocompromised patients.
ID: CRD42016048438.
侵袭性肺炎球菌病（IPD）与高发病率和死亡率相关，免疫功能低下患者（ICPs）风险尤其高。因此，指南建议对这些患者进行肺炎球菌疫苗接种。然而，指南几乎没有引用该人群中 IPD 的发病率研究作为依据。这可能导致人们对疫苗接种的重要性认识不足，以及疫苗接种率低。本系统评价和荟萃分析的目的是评估 ICP 中 IPD 的发病率。
我们系统地检索了 PubMed 和 Embase，以确定在 2017 年 12 月 6 日之前发表的包含与“发病率”、“发生率”、“肺炎球菌”、“肺炎链球菌”、“脑膜炎”、“败血症”或“菌血症”相关术语的英文研究。我们关注的是 HIV、移植和慢性炎症性疾病患者。
我们纳入了 45 项系统评价研究，这些研究报告了 IPD 的发病率或发生率，定义为从正常无菌部位分离出肺炎链球菌。对 38 项研究的随机效应荟萃分析显示，在非非洲国家接受晚期抗逆转录病毒治疗的 HIV 患者中，IPD 的发病率为 331/100,000 人年，在非洲国家为 318/100,000；自体或同种异体干细胞移植患者分别为 696 和 812/100,000；实体器官移植患者为 465/100,000；慢性炎症性疾病患者为 65/100,000。在健康对照组中，发病率为 10/100,000。
ICPs 感染 IPD 的风险增加，尤其是 HIV 患者和接受过移植的患者。基于我们的研究结果，我们建议对免疫功能低下的患者进行肺炎球菌疫苗接种。
PROSPERO 注册号：ID：CRD42016048438。
