肺炎患者中肺炎球菌多种血清型的高流行率及其相关危险因素。
High prevalence of multiple serotypes of pneumococci in patients with pneumonia and their associated risk factors.
作者信息
Dhoubhadel Bhim Gopal, Suzuki Motoi, Ishifuji Tomoko, Yaegashi Makito, Asoh Norichika, Ishida Masayuki, Hamaguchi Sugihiro, Aoshima Masahiro, Yasunami Michio, Ariyoshi Koya, Morimoto Konosuke
机构信息
Department of Respiratory Infections, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan.
Department of Global Health, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.
出版信息
Thorax. 2022 Apr 26;77(11):1121-30. doi: 10.1136/thoraxjnl-2021-217979.
BACKGROUND
Multiple serotypes of pneumococci have epidemiological and clinical implications, such as the emergence of non-vaccine serotypes and the acquisition of antimicrobial resistance. Prevalence of multiple serotypes of pneumococci in adults and their risk factors are not known.
METHODS
We enrolled adult patients from age ≥15 years with radiologically confirmed pneumonia in four hospitals across Japan. Pneumococcal pneumonia was defined with a pneumococcal bacterial density of ≥10/mL in sputum by quantitative PCR, and serotypes were determined. Pneumonias with a single serotype were categorised as single-serotype pneumococcal pneumonia and with two or more serotypes as multiple-serotype pneumococcal pneumonia. Multivariable logistic regression was used to assess the risk factors.
RESULTS
3470 patients (median age 77 years, IQR 65-85) were enrolled. Pneumococcal pneumonia was identified in 476 (18.3%, n=2605) patients. Multiple serotypes were detected in 42% of them. Risk of having multiple serotypes was low among patients who had received 23-valent pneumococcal polysaccharide vaccine (PPSV23) vaccines (adjusted OR 0.51 (95% CI 0.27 to 0.94)). Proportion of non-PCV7 PPSV23 serotypes in overall distribution of multiple serotypes was 67.4% (n=324/481) compared with 46.4% (n=128/276) in that of single serotypes (p=0.001). Serotypes 5, 9N/9L, 10A, 12/22/46, 17F and 35F were associated with multiple-serotype pneumonia, and serotypes 6A/6B, 23F, 11 and 6C/6D were associated with single-serotype pneumonia. Proportion of more invasive serotypes (serotypes 1, 5, 7F, 8) was significantly higher in multiple-serotype pneumonia (p=0.001).
CONCLUSIONS
Multiple serotypes of pneumococci are common in sputum of adult patients with pneumonia. The risk of multiple-serotype pneumococcal pneumonia is lower than that of single-serotype pneumococcal pneumonia among PPSV23-vaccinated patients.
TRIAL REGISTRATION NUMBER
UMIN000006909.
背景
肺炎球菌的多种血清型具有流行病学和临床意义，如非疫苗血清型的出现和抗菌药物耐药性的获得。成人肺炎球菌多种血清型的患病率及其危险因素尚不清楚。
方法
我们在日本四家医院招募了年龄≥15岁、经放射学确诊为肺炎的成年患者。通过定量PCR检测痰液中肺炎球菌细菌密度≥10/mL来定义肺炎球菌肺炎，并确定血清型。单一血清型的肺炎归类为单血清型肺炎球菌肺炎，两种或更多血清型的肺炎归类为多血清型肺炎球菌肺炎。采用多变量逻辑回归分析评估危险因素。
结果
共纳入3470例患者（中位年龄77岁，四分位间距65 - 85岁）。476例（18.3%，n = 2605）患者被确诊为肺炎球菌肺炎。其中42%检测到多种血清型。接种23价肺炎球菌多糖疫苗（PPSV23）的患者出现多种血清型的风险较低（校正比值比0.51（95%置信区间0.27至0.94））。在多血清型总体分布中，非PCV7 PPSV23血清型的比例为67.4%（n = 324/481），而在单血清型中为46.4%（n = 128/276）（p = 0.001）。血清型5、9N/9L、10A、12/22/46、17F和35F与多血清型肺炎相关，血清型6A/6B、23F、11和6C/6D与单血清型肺炎相关。多血清型肺炎中侵袭性更强的血清型（血清型1、5、7F、8）比例显著更高（p = 0.001）。
结论
肺炎球菌的多种血清型在成年肺炎患者的痰液中很常见。在接种PPSV23的患者中，多血清型肺炎球菌肺炎的风险低于单血清型肺炎球菌肺炎。
试验注册号
UMIN000006909。
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