From the Botswana-UPenn Partnership, Gaborone, Botswana.
Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, NC.
Pediatr Infect Dis J. 2018 Nov;37(11):1176-1183. doi: 10.1097/INF.0000000000002174.
Nasopharyngeal colonization precedes infections caused by Streptococcus pneumoniae. A more detailed understanding of interactions between S. pneumoniae and the nasopharyngeal microbiota of children could inform strategies to prevent pneumococcal infections.
We collected nasopharyngeal swabs from children 1 to 23 months of age in Botswana between August 2012 and June 2016. We tested samples for S. pneumoniae and common respiratory viruses using polymerase chain reaction. We sequenced the V3 region of the bacterial 16S ribosomal RNA gene and used random forest models to identify clinical variables and bacterial genera that were associated with pneumococcal colonization.
Mean age of the 170 children included in this study was 8.3 months. Ninety-six (56%) children were colonized with S. pneumoniae. Pneumococcal colonization was associated with older age (P = 0.0001), a lack of electricity in the home (P = 0.02) and household use of wood as a cooking fuel (P = 0.002). Upper respiratory symptoms were more frequent in children with S. pneumoniae colonization (60% vs. 32%; P = 0.001). Adjusting for age, nasopharyngeal microbiota composition differed in colonized and noncolonized children (P = 0.001). S. pneumoniae colonization was associated with a higher relative abundance of Moraxella (P = 0.001) and lower relative abundances of Corynebacterium (P = 0.001) and Staphylococcus (P = 0.03). A decision tree model containing the relative abundances of bacterial genera had 81% sensitivity and 85% specificity for the determination of S. pneumoniae colonization status.
S. pneumoniae colonization is associated with characteristic alterations of the nasopharyngeal microbiota of children. Prospective studies should determine if nasopharyngeal microbial composition alters the risk of pneumococcal colonization and thus could be modified as a novel pneumonia prevention strategy.
鼻咽定植先于肺炎链球菌引起的感染。更详细地了解肺炎链球菌与儿童鼻咽微生物群之间的相互作用，可以为预防肺炎球菌感染的策略提供信息。
我们于 2012 年 8 月至 2016 年 6 月期间在博茨瓦纳收集了 1 至 23 个月大的儿童的鼻咽拭子。我们使用聚合酶链反应检测样本中的肺炎链球菌和常见呼吸道病毒。我们对细菌 16S 核糖体 RNA 基因的 V3 区进行测序，并使用随机森林模型来确定与肺炎球菌定植相关的临床变量和细菌属。
本研究共纳入 170 名儿童，平均年龄为 8.3 个月。96 名（56%）儿童鼻咽定植有肺炎链球菌。肺炎球菌定植与年龄较大（P = 0.0001）、家中无电（P = 0.02）和家庭使用木材作为烹饪燃料（P = 0.002）有关。有肺炎球菌定植的儿童出现上呼吸道症状的频率更高（60% vs. 32%；P = 0.001）。调整年龄后，定植和未定植儿童的鼻咽微生物组成不同（P = 0.001）。肺炎链球菌定植与莫拉菌相对丰度较高（P = 0.001）和棒状杆菌（P = 0.001）和葡萄球菌（P = 0.03）相对丰度较低有关。包含细菌属相对丰度的决策树模型对确定肺炎球菌定植状态的灵敏度为 81%，特异性为 85%。
肺炎链球菌定植与儿童鼻咽微生物群的特征改变有关。前瞻性研究应确定鼻咽微生物组成是否改变肺炎球菌定植的风险，从而可以作为一种新的肺炎预防策略进行修改。
