Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Department of Immunology and Institute of Cellular and Molecular Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
Semin Respir Crit Care Med. 2020 Aug;41(4):455-469. doi: 10.1055/s-0040-1702193. Epub 2020 Jun 13.
With the notable exceptions of the United States and Canada in particular, the global burden of disease in adults due to invasive infection with the dangerous respiratory, bacterial pathogen, (pneumococcus) remains. This situation prevails despite the major successes of inclusion of polysaccharide conjugate vaccines (PCVs) in many national childhood immunization programs and associated herd protection in adults, as well as the availability of effective antimicrobial agents. Accurate assessment of the geographic variations in the prevalence of invasive pneumococcal disease (IPD) has, however, been somewhat impeded by the limitations imposed on the acquisition of reliable epidemiological data due to reliance on often insensitive, laboratory-based, pathogen identification procedures. This, in turn, may result in underestimation of the true burden of IPD and represents a primary focus of this review. Other priority topics include the role of PCVs in the changing epidemiology of IPD in adults worldwide, smoking as a risk factor not only in respect of increasing susceptibility for development of IPD, but also in promoting pneumococcal antibiotic resistance. The theme of pneumococcal antibiotic resistance has been expanded to include mechanisms of resistance to commonly used classes of antibiotics, specifically β-lactams, macrolides and fluoroquinolones, and, perhaps somewhat contentiously, the impact of resistance on treatment outcome. Finally, but no less importantly, the role of persistent antigenemia as a driver of a chronic, subclinical, systemic proinflammatory/procoagulant phenotype that may underpin the long-term sequelae and premature mortality of those adults who have recovered from an episode of IPD, is considered.
除了美国和加拿大这两个国家以外，成人因侵袭性呼吸道细菌病原体感染（肺炎球菌）而导致的全球疾病负担仍然存在。尽管在许多国家的儿童免疫计划中纳入多糖结合疫苗（PCV）并在成人中产生了群体保护作用，同时也有有效的抗菌药物，这种情况仍然存在。然而，由于依赖于通常不敏感的基于实验室的病原体鉴定程序，准确评估侵袭性肺炎球菌病（IPD）的地理分布变化受到了一定的阻碍。这反过来可能导致对 IPD 真实负担的低估，这也是本综述的主要重点。其他优先主题包括 PCV 在全球成人 IPD 流行病学变化中的作用、吸烟不仅是增加发生 IPD 的易感性的一个风险因素，而且还促进了肺炎球菌对抗生素的耐药性。肺炎球菌抗生素耐药性的主题已经扩展到包括对常用抗生素类别的耐药机制，特别是β-内酰胺类、大环内酯类和氟喹诺酮类，并且可能有些争议，还包括耐药性对治疗结果的影响。最后但同样重要的是，持续性菌血症作为慢性、亚临床、全身性促炎/促凝表型的驱动因素的作用，这种表型可能是那些从 IPD 发作中康复的成年人的长期后果和过早死亡的基础。
