Willis Rohan, Heslop Orville, Bodonaik Nabin, Thame Minerva, Smikle Monica
Department of Microbiology, Faculty of Medical Sciences.
Department of Child and Adolescent Health, Faculty of Medical Sciences.
Hum Antibodies. 2019;27(3):155-160. doi: 10.3233/HAB-180361.
Pneumococcal infections are a leading global cause of morbidity and mortality, complicated by the increasing antimicrobial resistance of pneumococcal isolates.
To evaluate morbidity and mortality associated with both invasive pneumococcal disease (IPD) and non-IPD in Jamaica in both the paediatric and adult population. Pneumococcal isolates (n= 94) were collected over a 2-year period (2008-2009).
Risk factors for poor clinical outcomes: death, complicated disease and length of hospitalization (LOH) were evaluated and antimicrobial resistance patterns were determined by Kirby-Bauer disc diffusion.
The case fatality rate was 6.8%. Independent mortality risk factors included complicated disease [OR 30.9 (3.4-276.6)] and diabetes mellitus [OR 8.3 (1.4-48.8)]. Independent risk factors for the development of complicated disease included sickle cell disease [OR 36.5 (4.2-320.3)] and sepsis [OR 3.5 (1.2-10.4)]. The LOH was increased most in patients with invasive disease (4.6-fold) and resistance to ceftriaxone (4.3-fold). Penicillin (16.0%) and erythromycin (14.9%) resistance was most prevalent, while ceftriaxone (4.3%) resistance was least prevalent.
The high burden of IPD in at-risk groups in our population and the associated increase in morbidity and mortality underlie the need for improved preventive and therapeutic management strategies in these patients.
肺炎球菌感染是全球发病和死亡的主要原因，且肺炎球菌分离株的抗菌耐药性不断增加，使情况更为复杂。
评估牙买加儿童和成人侵袭性肺炎球菌病（IPD）和非IPD的发病和死亡情况。在2年期间（2008 - 2009年）收集了94株肺炎球菌分离株。
评估不良临床结局（死亡、复杂疾病和住院时间（LOH））的危险因素，并通过 Kirby - Bauer 纸片扩散法确定抗菌耐药模式。
病死率为6.8%。独立的死亡危险因素包括复杂疾病[比值比（OR）30.9（3.4 - 276.6）]和糖尿病[OR 8.3（1.4 - 48.8）]。发生复杂疾病的独立危险因素包括镰状细胞病[OR 36.5（4.2 - 320.3）]和败血症[OR 3.5（1.2 - 10.4）]。侵袭性疾病患者的住院时间增加最多（4.6倍），对头孢曲松耐药的患者住院时间增加4.3倍。青霉素耐药率（16.0%）和红霉素耐药率（14.9%）最为普遍，而头孢曲松耐药率（4.3%）最不普遍。
我国高危人群中IPD负担沉重，且发病和死亡率相应增加，这表明需要改善这些患者的预防和治疗管理策略。
