在一个低收入和中等收入国家，合并症成年人中肺炎链球菌鼻咽部定植与不良结局的关系。
The relation of nasopharyngeal colonization by Streptococcus pneumoniae in comorbid adults with unfavorable outcomes in a low-middle income country.
作者信息
Olivella-Gomez Juan, Lozada Julián, Serrano-Mayorga Cristian C, Méndez-Castillo Lina, Acosta-González Alejandro, Viñán Garcés André Emilio, Bustos Ingrid G, Ibáñez-Prada Elsa D, Fuentes Yuli V, Crispin Ana M, Garcia-Garcia Erica Y, Santana Eveling, Josa Diego F, Pulido Saenz Jorge, Rodíguez-Castaño Gina Paola, Rodríguez Orjuela Jorge Alberto, Jaimes Diego, Tettelin Hervé, Orihuela Carlos J, Reyes Luis Felipe
机构信息
School of Medicine, Universidad de La Sabana, Chía, Colombia.
Unisabana Center for Translational Science, Universidad de La Sabana, Chía, Colombia.
出版信息
PLoS One. 2025 Feb 12;20(2):e0318320. doi: 10.1371/journal.pone.0318320. eCollection 2025.
PURPOSE
Streptococcus pneumoniae (Spn) is the primary bacterial cause of lower respiratory tract infections (LRTI) globally, particularly impacting older adults and children. While Spn colonization in children is linked to LRTI, its prevalence, and consequences in adults with comorbidities remain uncertain. This study aims to provide novel data in that regard.
METHODS
This prospective study of outpatient adults with chronic diseases was conducted in Colombia. Data on demographics, vaccination, and clinical history was collected in a RedCap database. Nasopharyngeal aspirate samples were examined for Spn colonization using traditional cultures and quantitative-real time polymerase chain reaction (q-rtPCR). Patients were followed for 18 months, with colonization prevalence calculated and factors influencing colonization and its impact on clinical outcomes analyzed through logistic regressions.
RESULTS
810 patients were enrolled, with 10.1% (82/810) identified as colonized. The mean (SD) age was 62 years (±15), and 48.6% (394/810) were female. Major comorbidities included hypertension (52.2% [423/810]), cardiac conditions (31.1% [252/810]), and chronic kidney disease (17.4% [141/810]). Among all, 31.6% (256/810) received the influenza vaccine in the previous year, and 10.7% (87/810) received anti-Spn vaccines. Chronic kidney disease (OR 95% CI; 2.48 [1.01-6.15], p = 0.04) and chronic cardiac diseases (OR 95% CI; 1.62 [0.99-2.66], p = 0.05) were independently associated with Spn colonization. However, colonization was not associated with the development of LRTI (OR 95%CI; 0.64 [0.14-2.79], p = 0.55) or unfavorable outcomes (OR 95% CI;1.17 [0.14-2.79], p = 0.54) during follow-up.
CONCLUSIONS
Chronic kidney and cardiac diseases are independently associated with Spn colonization. However, Spn colonization was not associated with LRTI/unfavorable outcomes in adult patients with chronic comorbidities in our cohort.
目的
肺炎链球菌（Spn）是全球下呼吸道感染（LRTI）的主要细菌病因，对老年人和儿童影响尤为严重。虽然儿童中的Spn定植与LRTI有关，但其在合并症成人中的患病率及后果仍不确定。本研究旨在提供这方面的新数据。
方法
这项针对患有慢性病的门诊成人的前瞻性研究在哥伦比亚进行。人口统计学、疫苗接种和临床病史数据收集于RedCap数据库。使用传统培养法和定量实时聚合酶链反应（q-rtPCR）检测鼻咽抽吸物样本中的Spn定植情况。对患者进行18个月的随访，计算定植患病率，并通过逻辑回归分析影响定植的因素及其对临床结局的影响。
结果
共纳入810例患者，其中10.1%（82/810）被确定为定植。平均（标准差）年龄为62岁（±15），48.6%（394/810）为女性。主要合并症包括高血压（52.2%[423/810]）、心脏疾病（31.1%[252/810]）和慢性肾病（17.4%[141/810]）。在所有患者中，31.6%（256/810）在前一年接种了流感疫苗，10.7%（87/810）接种了抗Spn疫苗。慢性肾病（比值比95%置信区间；2.48[1.01-6.15]，p = 0.04）和慢性心脏疾病（比值比95%置信区间；1.62[0.99-2.66]，p = 0.05）与Spn定植独立相关。然而，在随访期间，定植与LRTI的发生（比值比95%置信区间；0.64[0.14-2.79]，p = 0.55）或不良结局（比值比95%置信区间；1.17[0.14-2.79]，p = 0.54）无关。
结论
慢性肾病和心脏疾病与Spn定植独立相关。然而，在我们的队列中，Spn定植与患有慢性合并症的成年患者的LRTI/不良结局无关。
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