Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc., New York, NY, USA.
Emerging Markets Medical Affairs, Vaccines, Pfizer Inc., Paris, France.
J Hosp Infect. 2021 Feb;108:146-157. doi: 10.1016/j.jhin.2020.09.036. Epub 2020 Nov 8.
Hospital-acquired pneumonia (HAP) is often more severe and life-threatening than community-acquired pneumonia (CAP). The role of Streptococcus pneumoniae in CAP is well-understood, but its role in HAP is unclear. The objective of this study was to summarize the available literature on the prevalence of S. pneumoniae in HAP episodes. We searched MEDLINE for peer-reviewed articles on the microbiology of HAP in individuals aged ≥18 years, published between 2008 and 2018. We calculated pooled estimates of the prevalence of S. pneumoniae in episodes of HAP using a random-effects, inverse-variance-weighted meta-analysis. Forty-seven of 1908 articles met the inclusion criteria. Bacterial specimen isolation techniques for microbiologically defined HAP episodes included bronchoalveolar lavage, protective specimen brush, tracheobronchial aspirate and sputum, as well as blood culture. Culture was performed in all studies; five studies also used urine antigen detection (5/47; 10.6%). S. pneumoniae was identified in 5.1% (95% confidence interval (CI): 3.8-6.6%) of microbiologically defined HAP episodes (N = 20), with 5.4% (95% CI: 4.3-6.7%, N = 29) in ventilator-associated HAP and 6.0% (95% CI: 4.1-8.8%, N = 6) in non-ventilator-associated HAP. S. pneumoniae was identified in 5.3% (95% CI: 4.5-6.3%) of HAP occurring in the intensive care unit (ICU, N = 41) and in 5.6% (95% CI: 3.3-9.5%, N = 5) outside the ICU. A higher proportion of early-onset HAP (10.3%; 95% CI: 8.3-12.8%, N = 16) identified S. pneumoniae as compared with late-onset HAP (3.3%; 95% CI: 2.5-4.4%, N = 16). In conclusion, S. pneumoniae was identified by culture in 5.1% of microbiologically defined HAP episodes. The importance of HAP as part of the disease burden caused by S. pneumoniae merits further research.
医院获得性肺炎（HAP）通常比社区获得性肺炎（CAP）更严重和危及生命。肺炎链球菌在 CAP 中的作用已得到充分认识，但在 HAP 中的作用尚不清楚。本研究的目的是总结关于 HAP 发作中肺炎链球菌患病率的现有文献。我们在 MEDLINE 上搜索了 2008 年至 2018 年期间发表的关于≥18 岁个体 HAP 微生物学的同行评审文章。我们使用随机效应、倒数方差加权荟萃分析计算了 HAP 发作中肺炎链球菌患病率的汇总估计值。1908 篇文章中有 47 篇符合纳入标准。微生物学定义的 HAP 发作中细菌标本分离技术包括支气管肺泡灌洗、保护性标本刷、气管支气管抽吸和痰以及血培养。所有研究均进行了培养；5 项研究还使用了尿液抗原检测（5/47；10.6%）。肺炎链球菌在 5.1%（95%置信区间[CI]：3.8-6.6%）的微生物学定义的 HAP 发作中得到鉴定（N=20），其中呼吸机相关性 HAP 为 5.4%（95%CI：4.3-6.7%，N=29），非呼吸机相关性 HAP 为 6.0%（95%CI：4.1-8.8%，N=6）。肺炎链球菌在 ICU（N=41）中发生的 HAP 中占 5.3%（95%CI：4.5-6.3%），在 ICU 外发生的 HAP 中占 5.6%（95%CI：3.3-9.5%，N=5）。与迟发性 HAP（3.3%；95%CI：2.5-4.4%，N=16）相比，早期发病的 HAP（10.3%；95%CI：8.3-12.8%，N=16）中更多地鉴定出肺炎链球菌。总之，通过培养在 5.1%的微生物学定义的 HAP 发作中鉴定出肺炎链球菌。HAP 作为肺炎链球菌引起的疾病负担的一部分的重要性值得进一步研究。
