成人社区获得性肺炎住院患者中肺炎链球菌的携带情况。

Carriage of Streptococcus pneumoniae in adults hospitalised with community-acquired pneumonia.

机构信息

Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK; National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, UK.

出版信息

J Infect. 2024 Nov;89(5):106277. doi: 10.1016/j.jinf.2024.106277. Epub 2024 Sep 19.

DOI:10.1016/j.jinf.2024.106277

PMID:39306250

Abstract

OBJECTIVES

We aimed to determine the prevalence of and risk factors for nasopharyngeal and oral pneumococcal carriage in adults with community-acquired pneumonia (CAP), and the relationship between carried and disease-causing serotypes.

METHODS

Between 2016 and 2018, nasopharyngeal swabs, oral-fluid, and urine were collected from hospitalised adults recruited into a prospective cohort study of CAP. Pneumococcal carriage was detected by semi-quantitative real-time PCR of direct and culture-enriched nasopharyngeal swabs and culture-enriched oral-fluid. LytA and piaB positive/indeterminate samples underwent semi-quantitative serotype/serogroup-specific real-time-PCR. Serotypes in urine were identified using a 24-valent serotype-specific urinary-antigen assay.

RESULTS

We included 465 CAP patients. Nasopharyngeal carriage was detected in 34/103 (33.0%) swabbed pneumococcal pneumonia patients and oral carriage in 18/155 (12%) of sampled pneumococcal pneumonia patients. Concordance between nasopharyngeal/urine serotypes and oral/urine serotypes was 70.6% and 50% respectively. Serotypes 3 (26%, 22.2%), 8 (19.7%, 19.4%), non-typeable (11.6%, 13.9%) and 19A/F (7.5%, 8.3%) were most prevalent in urine and nasopharyngeal swabs respectively, with non-typeable (35%) and 15A/F (17%) most prevalent in oral-fluid. Pneumococcal carriage was significantly associated with pneumococcal pneumonia (nasopharyngeal adjusted odds ratio [aOR] 8.1, 95% confidence interval [CI] 3.8-17.2; oral aOR 5.5, 95% CI 2.1-13.3). All-cause CAP patients ≥65 years had lower odds of nasopharyngeal carriage (aOR 0.47, 95% CI 0.24-0.91) and current smokers had higher odds of oral carriage (aOR 2.69, 95% CI 1.10-6.60).

CONCLUSIONS

The association between nasopharyngeal carriage and pneumococcal CAP was strong. Adult carriage and disease from serotypes 8 and 19A may support direct protection of adults with PCV vaccines.

摘要

目的

我们旨在确定社区获得性肺炎（CAP）成人中鼻咽和口腔肺炎球菌携带的流行率和危险因素，以及携带和致病血清型之间的关系。

方法

2016 年至 2018 年，从纳入 CAP 前瞻性队列研究的住院成人中采集鼻咽拭子、口腔液和尿液。通过直接和培养富集鼻咽拭子和培养富集口腔液的半定量实时 PCR 检测肺炎球菌携带情况。LytA 和 piaB 阳性/不确定样本进行半定量血清型/血清群特异性实时 PCR。尿液中的血清型使用 24 价血清型特异性尿液抗原检测确定。

结果

我们纳入了 465 例 CAP 患者。在 103 例经拭子检测的肺炎球菌肺炎患者中，有 34 例（33.0%）检测到鼻咽携带，在 155 例经采样的肺炎球菌肺炎患者中，有 18 例（12%）检测到口腔携带。鼻咽/尿液血清型与口腔/尿液血清型的一致性分别为 70.6%和 50%。血清型 3（26%，22.2%）、8（19.7%，19.4%）、非分型（11.6%，13.9%）和 19A/F（7.5%，8.3%）在尿液和鼻咽拭子中最为常见，非分型（35%）和 15A/F（17%）在口腔液中最为常见。肺炎球菌携带与肺炎球菌肺炎显著相关（鼻咽调整优势比 [aOR]8.1，95%置信区间 [CI]3.8-17.2；口腔 aOR5.5，95%CI2.1-13.3）。≥65 岁的所有病因 CAP 患者鼻咽携带的可能性较低（aOR0.47，95%CI0.24-0.91），而当前吸烟者口腔携带的可能性较高（aOR2.69，95%CI1.10-6.60）。