Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and SA-MRC Unit on Child & Adolescent Health, University of Cape Town.
Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and SA-MRC Unit on Child & Adolescent Health, University of Cape Town.
Int J Infect Dis. 2022 Aug;121:31-38. doi: 10.1016/j.ijid.2022.04.043. Epub 2022 Apr 25.
The role of Klebsiella pneumoniae (KP) in lower respiratory tract infection (LRTI) is not well studied. We longitudinally investigated KP colonization and its association with LRTI in a South African birth cohort.
We conducted a case-control study of infants who developed LRTI and age-matched controls, followed twice weekly through infancy. Nasopharyngeal swabs taken fortnightly and at LRTI for 33-multipex Quantitative multiplex real-time polymerase chain reaction were tested at LRTI and twice weekly from 90 days preceding LRTI. Controls were tested over the equivalent period. Multivariate models investigated the factors associated with LRTI or with KP-associated LRTI (KP-LRTI).
Among 885 infants, there were 439 LRTI episodes, of which 68 (15.5%) were KP-LRTI (OR 1.93; 95% CI 1.25-3.03). Infants with KP-LRTI were younger than those without KP-LRTI (median [IQR] 3.7 [2.1-5.9] vs 4.7 [2.8-7.9] months, P-value=0.009). Clinical features of KP and non-KP-LRTI were similar with 114 (26%) infants hospitalized. Prematurity (adjusted odds ratio [aOR] 11.86; 95% CI 5.22-26.93), HIV exposure (aOR 3.32; 95% CI 1.69-6.53), lower birthweight (aOR 0.68; 95% CI 0.51-0.91), and shorter breastfeeding time (aOR 0.79; 95% CI 0.65-0.96) were associated with KP-LRTI versus non-LRTI. These factors and younger age were associated with KP-LRTI versus non-KP-LRTI.
KP was associated with a substantial proportion of LRTI, particularly in premature or HIV-exposed infants in whom strategies for treatment and prevention should be strengthened.
肺炎克雷伯菌（KP）在下呼吸道感染（LRTI）中的作用尚未得到充分研究。我们通过对南非一个出生队列进行的纵向研究，调查了 KP 定植及其与 LRTI 的关联。
我们对发生 LRTI 的婴儿和年龄匹配的对照婴儿进行了病例对照研究，在婴儿期每周随访两次。在 LRTI 时以及 LRTI 前 90 天内每两周进行一次鼻咽拭子采集，并进行 33 重多重实时聚合酶链反应（Multiplex Quantitative real-time polymerase chain reaction）检测。对照婴儿在相应时间段内进行检测。多变量模型调查了与 LRTI 或与 KP 相关的 LRTI（KP-LRTI）相关的因素。
在 885 名婴儿中，有 439 例发生 LRTI ，其中 68 例（15.5%）为 KP-LRTI（OR 1.93；95% CI 1.25-3.03）。与非 KP-LRTI 相比，KP-LRTI 婴儿的年龄更小（中位数[IQR] 3.7[2.1-5.9] vs 4.7[2.8-7.9] 个月，P 值=0.009）。114 例（26%）婴儿住院，KP 和非 KP-LRTI 的临床特征相似。早产（校正比值比[aOR] 11.86；95% CI 5.22-26.93）、HIV 暴露（aOR 3.32；95% CI 1.69-6.53）、低出生体重（aOR 0.68；95% CI 0.51-0.91）和母乳喂养时间较短（aOR 0.79；95% CI 0.65-0.96）与 KP-LRTI 相关，而非 LRTI。这些因素和年龄较小与 KP-LRTI 而非非 KP-LRTI 相关。
KP 与相当一部分 LRTI 相关，尤其是在早产或 HIV 暴露的婴儿中，应加强针对这些婴儿的治疗和预防策略。
