对 2010 年至 2017 年加拿大住院成年患者中非菌血症性和菌血症性肺炎链球菌社区获得性肺炎的校正估计值，其中包括一种扩展谱型特异性尿液抗原检测试验。
Recalibrated estimates of non-bacteremic and bacteremic pneumococcal community acquired pneumonia in hospitalized Canadian adults from 2010 to 2017 with addition of an extended spectrum serotype-specific urine antigen detection assay.
机构信息
Canadian Center for Vaccinology (CCfV), IWK Health Centre, Nova Scotia Health Authority (NSHA), and Dalhousie University, Halifax, Nova Scotia, Canada; Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority (NSHA), Halifax, Nova Scotia, Canada.
Canadian Center for Vaccinology (CCfV), IWK Health Centre, Nova Scotia Health Authority (NSHA), and Dalhousie University, Halifax, Nova Scotia, Canada.
出版信息
Vaccine. 2022 Apr 20;40(18):2635-2646. doi: 10.1016/j.vaccine.2022.02.081. Epub 2022 Mar 18.
OBJECTIVE(S): In the context of age- and risk-based pneumococcal vaccine recommendations in Canada, this study presents updated data from active surveillance of pneumococcal community acquired pneumonia (pCAP) and invasive pneumococcal disease (IPD) in hospitalized adults from 2010 to 2017.
METHODS
S. pneumoniae was detected using culture (blood and sputum), and urine antigen detection (UAD). Serotyping was performed with Quellung, PCR, or using the PCV13- and PPV23 (non-PCV13)-specific UADs. Laboratory results, demographic, and outcome data were categorized by age (16-49, 50-64, and 65 + ) and by disease [non-bacteremic pCAP, bacteremic pCAP, and IPD(non-CAP)].
RESULTS
11,129 CAP cases and 216 cases of IPD (non-CAP) were identified. Laboratory testing for S. pneumoniae was performed in 8912 CAP cases, identifying 1264 (14.2%) as pCAP. Of pCAP cases, 811 (64.1%) were non-bacteremic and 455 (35.9%) were bacteremic. Adults 65 + years represented 54.5% of non-bacteremic pCAP, 41.4% of bacteremic pCAP, and 48.6% of IPD cases. Adults 50-64 years contributed 30.3%, 33.1%, and 29.9%, respectively. In pCAP, PCV13 serotypes declined between 2010 and 2014 due to declines in serotypes 7F and 19A, then plateaued from 2015 to 2017 with persistence of serotype 3. In later study years, non-bacteremic pCAP was predominant, and PPV23 (non-PCV13) serotypes increased from 2015 to 2017, with serotypes 22F, 11A, and 9 N being most frequently identified. Compared to non-pCAP, pCAP cases were more likely to be admitted to intensive care units and require mechanical ventilation. These outcomes and mortality were more common in bacteremic pCAP and IPD, versus non-bacteremic pCAP.
CONCLUSION(S): Along with IPD, pCAP surveillance (bacteremic and non-bacteremic) is important as their trends may differ over time. With insufficient herd protection from PCV13 childhood immunization, or use of PPV23 in adults, this study supports direct adult immunization with PCV13 or higher valency conjugate vaccines to reduce the residual burden of pCAP and IPD.
目的
在加拿大基于年龄和风险的肺炎球菌疫苗推荐的背景下，本研究提供了 2010 年至 2017 年期间住院成人社区获得性肺炎（CAP）和侵袭性肺炎球菌病（IPD）的主动监测的最新数据。
方法
使用培养（血液和痰液）和尿抗原检测（UAD）检测肺炎链球菌。血清分型采用 Quellung、PCR 或使用 PCV13 和 PPV23（非 PCV13）特异性 UAD 进行。根据年龄（16-49 岁、50-64 岁和 65 岁及以上）和疾病[非菌血症性 CAP、菌血症性 CAP 和 IPD（非 CAP）]对实验室结果、人口统计学和结局数据进行分类。
结果
共确定了 11129 例 CAP 病例和 216 例 IPD（非 CAP）病例。对 8912 例 CAP 病例进行了肺炎链球菌实验室检测，其中 1264 例（14.2%）为 CAP。在 CAP 病例中，811 例（64.1%）为非菌血症性，455 例（35.9%）为菌血症性。65 岁及以上的成年人占非菌血症性 CAP 的 54.5%、菌血症性 CAP 的 41.4%和 IPD 病例的 48.6%。50-64 岁的成年人分别占 30.3%、33.1%和 29.9%。在 CAP 中，由于 7F 和 19A 血清型的下降，PCV13 血清型在 2010 年至 2014 年间下降，然后从 2015 年至 2017 年保持稳定，3 型持续存在。在后期研究年份中，非菌血症性 CAP 占主导地位，PPV23（非 PCV13）血清型从 2015 年至 2017 年增加，最常见的血清型为 22F、11A 和 9N。与非 CAP 相比，CAP 病例更有可能入住重症监护病房并需要机械通气。菌血症性 CAP 和 IPD 的这些结局和死亡率更为常见，而非菌血症性 CAP 则较少见。
结论
与 IPD 一样，CAP 监测（菌血症性和非菌血症性）很重要，因为其趋势可能随时间而变化。由于儿童 PCV13 免疫接种的群体保护不足，或成人使用 PPV23，本研究支持对成人进行直接免疫接种，使用 PCV13 或更高价结合疫苗，以减少 CAP 和 IPD 的残余负担。
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