Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden.
Panzi Hospital, Bukavu, Democratic Republic of the Congo.
BMC Pediatr. 2018 Nov 19;18(1):361. doi: 10.1186/s12887-018-1332-3.
Pneumococcal conjugate vaccines have been introduced in the infant immunisation programmes in many countries to reduce the rate of fatal pneumococcal infections. In the Democratic Republic of the Congo (DR Congo) a 13-valent vaccine (PCV13) was introduced in 2013. Data on the burden of circulating pneumococci among children after this introduction are lacking. In this study, we aimed to determine the risk factors related to pneumococcal carriage in healthy Congolese children after the vaccine introduction and to assess the antibiotic resistance rates and serotype distribution among the isolated pneumococci.
In 2014 and 2015, 794 healthy children aged one to 60 months attending health centres in the eastern part of DR Congo for immunisation or growth monitoring were included in the study. Data on socio-demographic and medical factors were collected by interviews with the children's caregivers. Nasopharyngeal swabs were obtained from all the children for bacterial culture, and isolated pneumococci were further tested for antimicrobial resistance using disc diffusion tests and, when indicated, minimal inhibitory concentration (MIC) determination, and for serotype/serogroup by molecular testing.
The pneumococcal detection rate was 21%, being higher among children who had not received PCV13 vaccination, lived in rural areas, had an enclosed kitchen, were malnourished or presented with fever (p value < 0.05). The predominant serotypes were 19F, 11, 6A/B/C/D and 10A. More than 50% of the pneumococcal isolates belonged to a serotype/serogroup not included in PCV13. Eighty per cent of the isolates were not susceptible to benzylpenicillin and non-susceptibility to ampicillin and ceftriaxone was also high (42 and 37% respectively). Almost all the isolates (94%) were resistant to trimethoprim-sulphamethoxazole, while 43% of the strains were resistant to ≥3 antibiotics.
Our study shows alarmingly high levels of reduced susceptibility to commonly used antibiotics in pneumococci carried by healthy Congolese children. This highlights the importance of local antibiotic resistance surveillance and indicates the needs for the more appropriate use of antibiotics in the area. The results further indicate that improved living conditions are needed to reduce the pneumococcal burden, in addition to PCV13 vaccination.
许多国家已在婴儿免疫计划中引入肺炎球菌结合疫苗，以降低致命性肺炎球菌感染的发生率。在刚果民主共和国（DRC），2013 年引入了 13 价疫苗（PCV13）。在此引入之后，关于儿童中循环肺炎球菌负担的数据尚缺乏。在这项研究中，我们旨在确定疫苗引入后健康刚果儿童中与肺炎球菌携带相关的危险因素，并评估分离肺炎球菌的抗生素耐药率和血清型分布。
2014 年和 2015 年，研究纳入了 794 名在刚果民主共和国东部的卫生中心接受免疫接种或生长监测的 1 至 60 月龄的健康儿童。通过与儿童照顾者的访谈收集社会人口统计学和医疗因素数据。从所有儿童中采集鼻咽拭子进行细菌培养，进一步用纸片扩散试验检测分离的肺炎球菌的抗生素耐药性，在必要时通过最小抑菌浓度（MIC）测定，以及通过分子检测检测血清型/血清群。
肺炎球菌检出率为 21%，未接种 PCV13 疫苗、居住在农村地区、厨房封闭、营养不良或发热的儿童检出率更高（p 值<0.05）。主要血清型为 19F、11、6A/B/C/D 和 10A。超过 50%的肺炎球菌分离株属于未包含在 PCV13 中的血清型/血清群。80%的分离株对青霉素不敏感，对氨苄西林和头孢曲松的不敏感性也很高（分别为 42%和 37%）。几乎所有分离株（94%）对甲氧苄啶-磺胺甲噁唑耐药，而 43%的菌株对≥3 种抗生素耐药。
我们的研究表明，健康刚果儿童携带的肺炎球菌对常用抗生素的敏感性降低程度令人震惊。这突出表明需要进行当地抗生素耐药性监测，并表明在该地区需要更合理地使用抗生素。研究结果进一步表明，除了 PCV13 疫苗接种外，还需要改善生活条件以降低肺炎球菌负担。
