Pediatric Infectious Diseases Unit, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, P.O. Box 9602, 31096, Haifa, Israel.
Microbiology Laboratory, Rambam Health Care Campus, Haifa, Israel.
Eur J Clin Microbiol Infect Dis. 2021 Jul;40(7):1433-1439. doi: 10.1007/s10096-021-04167-9. Epub 2021 Feb 3.
The purpose of this study was to estimate the impact of pneumococcal conjugate vaccine-13 (PCV-13) introduction into the national immunization program in Israel on pneumococcal and non-pneumococcal pediatric community-acquired bacteremia (CAB). This is a retrospective cohort study, including children ≤ 18 years old with CAB, who were hospitalized in Rambam Health Care Campus, a tertiary medical center serving northern Israel, between the years 2004 and 2016. The proportional admission rate of pneumococcal bacteremia among all CAB events and the incidence of CAB and pneumococcal bacteremia per 1000 hospital admissions were compared between the pre- and post-pneumococcal vaccine eras. A total of 275 CAB events were identified. Common isolates were Streptococcus pneumoniae (SPn) (26.9%), Staphylococcus aureus (12.4%), Brucella spp. (11.6%), E. coli (10.9%), and Streptococcus pyogenes (5.8%). The pneumococcal bacteremia rate per 1000 hospital admissions decreased significantly from 1.59 to 0.6 (p < 0.001). The proportional pneumococcal bacteremia rate decreased from 55 (34.4%) to 19 (16.5%) (p 0.001). Penicillin resistance among pneumococcal isolates decreased dramatically from 50.9 to 5.3% (p < 0.001). The rate of bacteremia caused by other pathogens has not been changed significantly at the post-vaccination era (p 0.053). However, an increase in the incidence of S. pyogenes bacteremia from 1.9 to 11.3% (p < 0.001) was noticed. In addition, an outbreak of Brucella bacteremia occurred during the years 2015-2016. This study demonstrates the double positive effect of PVC-13 introduction: a sharp decrease in the proportional rate of pneumococcal bacteremia and in the resistance of SPn to penicillin. Also, there was a moderate decline in the incidence of CAB in exception to bacteremia caused by S. pyogenes. This trend was reversed due to a Brucella outbreak.
本研究旨在评估肺炎球菌结合疫苗 13 型（PCV-13）纳入以色列国家免疫计划对儿童社区获得性肺炎球菌和非肺炎球菌菌血症（CAB）的影响。这是一项回顾性队列研究，纳入了 2004 年至 2016 年期间在服务于以色列北部的三级医疗中心 Rambam 医疗保健园区因 CAB 住院的≤18 岁儿童。比较了疫苗前和疫苗后时代所有 CAB 事件中肺炎球菌菌血症的比例入院率和 CAB 及肺炎球菌菌血症的发病率每 1000 例住院患者。共确定了 275 例 CAB 事件。常见分离株为肺炎链球菌（SPn）（26.9%）、金黄色葡萄球菌（12.4%）、布鲁氏菌属（11.6%）、大肠杆菌（10.9%）和化脓性链球菌（5.8%）。每 1000 例住院患者的肺炎球菌菌血症率从 1.59 降至 0.6（p<0.001）。肺炎球菌菌血症的比例从 55（34.4%）降至 19（16.5%）（p<0.001）。肺炎球菌分离株的青霉素耐药率从 50.9%降至 5.3%（p<0.001）。疫苗接种后时代，其他病原体引起的菌血症率无显著变化（p>0.053）。然而，化脓性链球菌菌血症的发病率从 1.9%增至 11.3%（p<0.001）。此外，2015-2016 年期间还发生了布鲁氏菌菌血症爆发。本研究表明 PCV-13 引入的双重积极影响：肺炎球菌菌血症的比例和 SPn 对青霉素的耐药性均显著下降。此外，CAB 的发病率也适度下降，除了由化脓性链球菌引起的菌血症。这种趋势因布鲁氏菌爆发而逆转。
