10年间（2013 - 2023年）社区获得性肺炎住院成人的肺炎球菌肺炎趋势及3型血清型的作用

Pneumococcal pneumonia trends in adults hospitalised with community-acquired pneumonia over 10 years (2013-2023) and the role of serotype 3.

作者信息

Lansbury Louise, McKeever Tricia M, Lawrence Hannah, Pick Harry, Baskaran Vadsala, Edwards-Pritchard Rochelle, Matthews Laura, Bailey Helen, Ashton Deborah, Bendall Lesley, Rodrigo Chamira, Daniel Priya, Litt David, Eletu Seyi, Parmar Hanshi, Sheppard Carmen, Ladhani Shamez N, Trotter Caroline, Lim Wei Shen

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, Nottingham, UK.

出版信息

Thorax. 2025 Jan 17;80(2):86-96. doi: 10.1136/thorax-2024-221976.

DOI:10.1136/thorax-2024-221976

PMID:39667904

Abstract

BACKGROUND

With higher valency pneumococcal vaccines on the horizon and new adult immunisation strategies under discussion, we aimed to evaluate the contribution of individual pneumococcal serotypes to the burden of pneumococcal community-acquired pneumonia (CAP). Over 10 years, trends in pneumococcal pneumonia epidemiology in adults hospitalised with CAP were assessed. The risk factors and severity associated with serotype 3 were examined.

METHODS

We conducted a prospective cohort study of adults hospitalised with CAP between September 2013 and May 2023. Pneumococcal serotypes were identified using a serotype-specific 24-valent urinary-antigen assay. Trends in the proportion of CAP due to pneumococcus and causative serotypes were compared prepandemic and postpandemic. Risk factors and severity of serotype 3 pneumonia were compared with other serotypes using logistic regression.

RESULTS

Of 5186 patients with CAP, 2193 (42.2%) had pneumococcal pneumonia. The proportion of CAP due to pneumococcus increased across all ages between 2013 and 2023 (36.4%-66.9%, p<0.001). The proportion due to serotype 3 increased significantly from 13.4% (2013) to 48.8% (2023). Serotype 3 pneumonia in adults was associated with older age (p<0.001), male sex (adjusted OR (aOR) 2.22, 95% CI 1.64 to 3.01) and chronic renal disease (aOR 1.81, 95% CI 1.09 to 3.02). Serotype 3 pneumonia was not observed to be associated with severity, critical care requirement, mortality or readmission.

INTERPRETATION

Serotype 3 is the predominant serotype in adult pneumococcal CAP and has been increasing despite a mature infant pneumococcal immunisation programme, consistent with a lack of herd protection for this serotype.

摘要

背景

随着更高价次的肺炎球菌疫苗即将问世，以及新的成人免疫策略正在讨论中，我们旨在评估各肺炎球菌血清型对肺炎球菌社区获得性肺炎（CAP）负担的贡献。在10多年的时间里，评估了因CAP住院的成人肺炎球菌肺炎的流行病学趋势。研究了与3型血清型相关的危险因素和严重程度。

方法

我们对2013年9月至2023年5月因CAP住院的成人进行了一项前瞻性队列研究。使用血清型特异性24价尿抗原检测法鉴定肺炎球菌血清型。比较了大流行前和大流行后肺炎球菌引起的CAP比例和致病血清型的趋势。使用逻辑回归比较3型血清型肺炎与其他血清型的危险因素和严重程度。

结果

在5186例CAP患者中，2193例（42.2%）患有肺炎球菌肺炎。2013年至2023年期间，各年龄段因肺炎球菌引起的CAP比例均有所增加（36.4%-66.9%，p<0.001）。3型血清型引起的比例从2013年的13.4%显著增加到2023年的48.8%。成人3型血清型肺炎与年龄较大（p<0.001）、男性（调整后的比值比（aOR）2.22，95%置信区间1.64至3.01）和慢性肾病（aOR 1.81，95%置信区间1.09至3.02）相关。未观察到3型血清型肺炎与严重程度、重症监护需求、死亡率或再入院有关。