Chacon-Cruz Enrique, Rivas-Landeros Rosa Maria, Volker-Soberanes Maria Luisa, Lopatynsky-Reyes Erika Zoe, Becka Chandra, Alvelais-Palacios Jorge Arturo
Department of Pediatrics, Hospital General de Tijuana, Paseo Centenario S/N, Zona Rio, Tijuana, Baja California 22010, Mexico.
Microbiology Laboratory, Hospital General de Tijuana, Baja California, Mexico.
Ther Adv Infect Dis. 2019 Apr 3;6:2049936119839312. doi: 10.1177/2049936119839312. eCollection 2019 Jan-Dec.
Previous publications have proved the effectiveness of the 13-valent pneumococcal conjugate vaccine (PCV13) on pneumococcal pleural empyema (PnPE) in children, with little emergence of other pathogens. We searched the literature to establish whether PCV13 reduces PnPE, and to identify other pathogens causing pleural empyemas (PEs).
From October 2005 to January 2018 (12.3 years) we performed active surveillance for all cases of PE at the General Hospital of Tijuana, Mexico. Isolates from pleural fluid (PF) were identified by conventional culture, and since 2014, polymerase chain reaction (PCR) was added for all culture-negative PFs. serotypes were detected by either Quellung reaction (Statens Serum Institute®) or PCR. Clinical, imagenological, laboratorial and microbiological evaluation was performed on each patient. Statistical analysis was purely descriptive.
A total of 64 PEs were identified (5.28/year). Median age was 51 months (1-191), hospitalization days 18 (4-35). Decortication was performed in 42%, and two children died (3.2%). Bacterial identification was obtained from 51 (80%). was the leading cause (29 = 56.8%), followed by (14 = 27.4%), (3-5 = 9%) and others (5 = 9.8%). PCV13 was initiated in May 2012, and its impact on serotype-specific PnPE was 81% (much fewer than serotype 3) and for all PnPE 56.1%; however, for all PE -2.1% due to an increase of PE caused by for all but one methicillin-resistant (MRSA).
Following 12.3 years of active surveillance, PCV13 has shown impact on both serotype-specific and all PnPEs; however, an increase of PEs by MRSA has emerged. Continuous surveillance is crucial to establish whether this epidemiological finding is transitory or not.
既往研究已证实13价肺炎球菌结合疫苗（PCV13）对儿童肺炎球菌性胸腔积脓（PnPE）有效，且很少出现其他病原体。我们检索文献以确定PCV13是否能降低PnPE的发病率，并识别导致胸腔积脓（PE）的其他病原体。
2005年10月至2018年1月（12.3年），我们在墨西哥蒂华纳总医院对所有PE病例进行了主动监测。通过传统培养法鉴定胸腔积液（PF）中的分离株，自2014年起，对所有培养阴性的PF增加了聚合酶链反应（PCR）检测。通过荚膜肿胀反应（Statens Serum Institute®）或PCR检测血清型。对每位患者进行临床、影像学、实验室和微生物学评估。统计分析纯属描述性分析。
共确诊64例PE（每年5.28例）。中位年龄为51个月（1 - 191个月），住院天数为18天（4 - 35天）。42%的患者接受了胸膜剥脱术，2名儿童死亡（3.2%）。51例（80%）获得了细菌鉴定结果。肺炎链球菌是主要病因（29例 = 56.8%），其次是金黄色葡萄球菌（14例 = 27.4%）、肺炎克雷伯菌（3 - 5例 = 9%）和其他细菌（5例 = 9.8%）。PCV13于2012年5月开始使用，其对血清型特异性PnPE的影响为81%（远低于3型血清型），对所有PnPE的影响为56.1%；然而，对于所有PE病例，由于除1株耐甲氧西林金黄色葡萄球菌（MRSA）外，由金黄色葡萄球菌引起的PE病例增加，导致总体影响为 - 2.1%。
经过12.3年的主动监测，PCV13已显示出对血清型特异性和所有PnPE病例均有影响；然而，MRSA引起的PE病例有所增加。持续监测对于确定这一流行病学发现是否为暂时现象至关重要。
