Department of Medical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
Department of Medical Microbiology, Marmara University, Pendik Training and Research Hospital, Istanbul, Turkey.
Ann Med. 2023 Dec;55(1):266-275. doi: 10.1080/07853890.2022.2160877.
To evaluate the serotype distribution and antibiotic resistance in pneumococcal infections in adults and to provide a perspective regarding serotype coverage of both current and future pneumococcal vaccines.
This passive surveillance study was conducted with the strains isolated from the specimens of patients with pneumonia (materials isolated from bronchoalveolar lavage), bacteraemia, meningitis, pleuritis and peritonitis between 2015 and 2018. Serogrouping and serotyping were performed by latex particle agglutination and by conventional Quellung reaction using commercial type-specific antisera, respectively. The strains were analysed for penicillin, cefotaxime, erythromycin and moxifloxacin susceptibilities by E-test.
In the whole study group (410 samples from adults aged ≥18 years), the most frequent serotypes were 3 (14.1%), 19 F (12%) and 1 (9.3%). The vaccine coverage for PCV13, PCV15, PCV20 and PPV23 was 63.9%, 66.6%, 74.1% and 75.9%, respectively, in all isolates. Penicillin non-susceptibility in invasive pneumococcal disease (IPD) was 70.8% and 57.1% in the patients aged <65 and ≥65 years, respectively. About 21.1% and 4.3% of the patients with and without IPD had cefotaxime resistance. Non-susceptibility to erythromycin and moxifloxacin was 38.2% and 1.2%, respectively.
The results revealed that novel PCV vaccines may provide improved coverage as compared with the currently available vaccine, PCV13. The significant antibiotic resistance rates imply the need to extend the serotype coverage of the vaccines. Continuing the surveillance in pneumococcal diseases is critical to explore the serotype distribution and incidence changes of IPD cases in the population and to inform policy makers to make necessary improvements in the national immunization programmes.Key messagesThis multicentre study demonstrated the most recent serotype distribution and antibiotic resistance in adult population in Turkey.Shifting from PCV13 to novel conjugated vaccines will significantly increase the coverage.Continuing the surveillance in pneumococcal diseases is critical to explore the serotype distribution changes and the incidence of cases with invasive pneumococcal disease in the population.
评估成人肺炎球菌感染的血清型分布和抗生素耐药性，并提供当前和未来肺炎球菌疫苗的血清型覆盖范围的视角。
本项被动监测研究对 2015 年至 2018 年间从肺炎患者（支气管肺泡灌洗液中的标本）、菌血症、脑膜炎、胸膜炎和腹膜炎患者的标本中分离出的菌株进行了研究。采用乳胶粒子凝集法和常规的-Quellung 反应分别进行血清群和血清型鉴定，使用商业型特异性抗血清。采用 E 试验法分析菌株对青霉素、头孢噻肟、红霉素和莫西沙星的敏感性。
在整个研究组（410 份来自年龄≥18 岁的成年人的样本）中，最常见的血清型是 3 型（14.1%）、19F 型（12%）和 1 型（9.3%）。所有分离株中，PCV13、PCV15、PCV20 和 PPV23 的疫苗覆盖率分别为 63.9%、66.6%、74.1%和 75.9%。侵袭性肺炎球菌病（IPD）患者中青霉素不敏感率分别为 70.8%和 57.1%，年龄<65 岁和≥65 岁的患者分别为 70.8%和 57.1%。约 21.1%和 4.3%的 IPD 患者和无 IPD 患者对头孢噻肟有耐药性。对红霉素和莫西沙星的不敏感率分别为 38.2%和 1.2%。
结果表明，与目前可用的疫苗 PCV13 相比，新型 PCV 疫苗可能提供更好的覆盖范围。抗生素耐药率显著意味着需要扩大疫苗的血清型覆盖范围。继续对肺炎球菌病进行监测对于探索人群中 IPD 病例的血清型分布和发病率变化以及为决策者提供信息以改进国家免疫规划至关重要。
本项多中心研究显示了土耳其成人人群中最新的血清型分布和抗生素耐药性。从 PCV13 转向新型结合疫苗将显著提高覆盖率。继续对肺炎球菌病进行监测对于探索人群中肺炎球菌疾病的血清型分布变化以及侵袭性肺炎球菌病的发病率至关重要。
