Hospital de Nens de Barcelona, Barcelona, Spain.
Agència de Salut Publica de Catalunya, Generalitat de Catalunya, Barcelona, Spain.
Pediatr Pulmonol. 2019 May;54(5):517-524. doi: 10.1002/ppul.24279. Epub 2019 Feb 19.
The aim was to analyze the epidemiological, microbiological and clinical characteristics of patients with complicated pneumococcal pneumonia with pleural effusion (PE) or empyema.
Prospective study in three Catalan hospitals in persons aged <18 years diagnosed with complicated pneumonia with PE or empyema with isolation of Streptococcus pneumoniae in blood or pleural fluid by culture or real-time PCR between January 2012 and June 2016. Patients were divided into <2 years and 2-17 years age groups. Epidemiological, microbiological, and clinical data of patients were compared annually in both groups. PCV13 vaccination coverage increased from 48.2% in 2012 to 74.5% in 2015.
We included 143 patients. The incidence of pneumococcal pneumonia was 6.83 cases × 10 persons/year in cases with PE or empyema and 2.09 cases × 10 person-years in cases without (rate ratio [RR]: 3.27; 2.25-4.86; P < 0.001). Empyema was more frequent than PE (79.7% vs 20.3%, P < 0.005). Of 143 cases studied, 93 (65.0%, P < 0.001) were diagnosed by real-time-PCR, 43 (30.1%) by culture and RT-PCR and 7 (4.9%) by culture only. PCV13 serotypes were more frequent in complicated than in uncomplicated pneumonia (116/142, 81.7% vs 27/45, 60.0%; P = 0.003), especially serotype 1 (41/142, 28.9% vs 6/45, 13.3%, P : 0.036). From 2012 to 2015 there was a significant reduction in serotype 1 (16/43, 37.2% vs 3/27, 11.1%, P = 0.026), and a trend to an increase in non-PCV13 serotypes (6/43, 14% vs 9/27, 33.3%, P = 0.054).
A directly proportional relationship was observed between the reduction in pneumonia complicated with PE or empyema and a significant reduction in PCV13 serotypes, especially serotype 1, coinciding with increased PCV13 coverage.
分析伴有胸腔积液（PE）或积脓的复杂性肺炎链球菌性肺炎患者的流行病学、微生物学和临床特征。
2012 年 1 月至 2016 年 6 月，在加泰罗尼亚的 3 家医院对年龄＜18 岁的、经培养或实时 PCR 从血或胸腔积液中分离出肺炎链球菌的伴有 PE 或积脓的复杂性肺炎患者进行前瞻性研究。将患者分为＜2 岁和 2-17 岁年龄组。比较两组患者的流行病学、微生物学和临床数据。PCV13 疫苗接种覆盖率从 2012 年的 48.2%增加到 2015 年的 74.5%。
共纳入 143 例患者。伴有 PE 或积脓的肺炎链球菌性肺炎发生率为 6.83 例×10 人/年，无 PE 或积脓的肺炎发生率为 2.09 例×10 人/年（发病率比[RR]：3.27；2.25-4.86；P＜0.001）。积脓的发生率高于胸腔积液（79.7% vs 20.3%，P＜0.005）。在研究的 143 例患者中，93 例（65.0%，P＜0.001）通过实时-PCR、43 例（30.1%）通过培养和 RT-PCR、7 例（4.9%）通过培养确诊。与无复杂性肺炎相比，PCV13 血清型在复杂性肺炎中更为常见（116/142，81.7% vs 27/45，60.0%；P=0.003），尤其是血清型 1（41/142，28.9% vs 6/45，13.3%；P=0.036）。2012 年至 2015 年，血清型 1 的比例显著下降（16/43，37.2% vs 3/27，11.1%；P=0.026），而非 PCV13 血清型的比例呈上升趋势（6/43，14% vs 9/27，33.3%；P=0.054）。
PE 或积脓合并肺炎发生率与 PCV13 血清型（尤其是血清型 1）显著减少呈正相关，这与 PCV13 覆盖率的增加相一致。
