Department of Infectious Diseases, Istituto Superiore di Sanità, Rome.
Italian Federation of General Practitioners (Federazione Italiana Medici di Medicina Generale, FIMMG), Rome, Italy.
Vaccine. 2019 Aug 14;37(35):5096-5103. doi: 10.1016/j.vaccine.2019.06.052. Epub 2019 Jul 5.
Data on Streptococcus pneumoniae carriage in adults with co-morbidities are limited. In this study we estimated the pneumococcal carriage among adults with co-morbidities and evaluated socio-demographic and clinical risk factors. The potential coverage of the current pneumococcal vaccines recommended for adults (PCV13 and PPV23) was also investigated.
A cross-sectional study on S. pneumoniae carriage among unvaccinated adults ≥50 years with co-morbidities, presenting with or without acute respiratory symptoms at general practitioners in Rome, Italy, between October 2015 and July 2016 was conducted. Pneumococcal carriage was investigated by both cultural and molecular methods. Socio-demographic variables and co-morbidities were evaluated by logistic models as possible risk factors for pneumococcal carriage.
Out of 248 patients (median age: 73 yrs; IQR: 65-79), 12 (4.8%) and 83 (33.5%) individuals were found colonized using cultural or molecular methods, respectively. Potential risk factors for pneumococcal colonization as ascertained by molecular methods were: low level of education (adjusted OR = 3.71, 95% CI: 1.62-9.40), winter months (December-March vs other months, adjusted OR = 2.56, 95% CI: 1.29-5.14), and presence of chronic lung diseases (adjusted OR = 2.18, 95% CI: 1.15-4.16). The combination of serotype-specific multiplex RT-PCR and conventional PCR allowed to identify 22 serotypes/group of serotypes, of which the most common were: 24F/24A/24B, 12F/12A/12B/44/46, 6A/6B, 14, 15B/15C, and 22F/22A. Prevalence of pneumococcal carriage due to PCV13 serotypes and non-PCV13 serotypes was 23.6% and 67.3%, respectively. Prevalence of colonization due to PPV23 serotypes was estimated to be 54.6%.
A high prevalence of S. pneumoniae carriage was observed among adults with co-morbidities, especially among individuals affected by chronic lung diseases. These results support vaccine strategies based on the sequential administration of PCV13 and PPV23 to control potentially invasive pneumococcal strains in adults, especially in subjects with co-morbidities.
合并症成年人中肺炎球菌定植的数据有限。在这项研究中，我们估计了合并症成年人中的肺炎球菌定植情况，并评估了社会人口统计学和临床危险因素。还研究了目前推荐用于成年人的肺炎球菌疫苗（PCV13 和 PPV23）的潜在覆盖范围。
对意大利罗马的全科医生在 2015 年 10 月至 2016 年 7 月期间治疗的合并症、有或无急性呼吸道症状的 50 岁以上未接种疫苗的成年人中 S. pneumoniae 定植情况进行了横断面研究。通过培养和分子方法研究肺炎球菌定植情况。使用逻辑模型评估社会人口统计学变量和合并症，作为肺炎球菌定植的可能危险因素。
在 248 名患者中（中位年龄：73 岁；IQR：65-79），分别通过培养和分子方法发现 12 名（4.8%）和 83 名（33.5%）个体定植。通过分子方法确定的肺炎球菌定植的潜在危险因素为：低教育水平（调整 OR=3.71，95%CI：1.62-9.40）、冬季（12 月至 3 月）与其他月份（调整 OR=2.56，95%CI：1.29-5.14），以及存在慢性肺部疾病（调整 OR=2.18，95%CI：1.15-4.16）。血清型特异性多重 RT-PCR 和常规 PCR 的组合可鉴定 22 个血清型/血清型组，其中最常见的为 24F/24A/24B、12F/12A/12B/44/46、6A/6B、14、15B/15C 和 22F/22A。PCV13 血清型和非 PCV13 血清型引起的肺炎球菌定植率分别为 23.6%和 67.3%。PPV23 血清型引起的定植率估计为 54.6%。
在合并症成年人中，肺炎球菌定植率较高，尤其是患有慢性肺部疾病的成年人。这些结果支持基于 PCV13 和 PPV23 序贯接种的疫苗策略，以控制成年人中潜在的侵袭性肺炎球菌菌株，特别是在合并症患者中。
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