Savrasova Larisa, Villerusa Anita, Zeltina Indra, Krumina Angelika, Cupeca Hedija, Balasegaram Sooria, Greve Mara, Savicka Oksana, Selderina Solvita, Galajeva Jelena, Dushacka Diana
Institute of Public Health, Riga Stradinš University, Riga, Latvia.
Riga East University Hospital Riga, Riga, Latvia.
Front Public Health. 2025 Mar 12;13:1501821. doi: 10.3389/fpubh.2025.1501821. eCollection 2025.
is a major cause of Invasive pneumococcal disease (IPD), including bacteremic pneumonia, septicemia, and meningitis. The introduction of pneumococcal conjugate vaccines (PCVs) has significantly reduced the incidence of IPD caused by vaccine-covered serotypes. However, serotype replacement and antimicrobial resistance remain concerns. In Latvia, vaccination against pneumococcal disease was introduced into the NIP in 2010 with PCV7, later transitioning to PCV10 in 2012 and to PCV15 in 2024. This study aims is to determine the changes in antimicrobial resistance and its association with PCV10 serotypes in Latvia.
We conducted a population-based cross-sectional study using IPD surveillance data from Latvia over an 11-year period (2012-2022). IPD cases were defined according to the European Union case definition. Serotyping and antimicrobial susceptibility testing were performed on isolates from normally sterile sites. We analyzed the differences in IPD incidence, serotype distribution, and antimicrobial resistance using chi-square tests and multivariable logistic regression was used to determine associations between antimicrobial resistance and risk factors.
A total of 811 IPD cases were reported, with significant differences observed across the study period ( < 0.001). The most common serotypes were 3 and 19A. The proportion of IPD cases caused by PCV10 serotypes significantly decreased over the years, while cases caused by PCV13, PCV15, and PPPV23 serotypes increased. Antimicrobial susceptibility testing revealed resistance rates of 3.8% to penicillin, 5.4% to erythromycin, and 1.2% to cefotaxime/ceftriaxone. Erythromycin resistance showed significant variation over time ( = 0.016), decreasing from 7.1% in 2012 to 4.8% in 2022. Multivariable logistic regression indicated that IPD cases with PCV10 serotypes and meningitis were significantly associated with an increased likelihood of penicillin and erythromycin resistance.
The study highlights a decrease in erythromycin resistance in IPD cases over time and significant associations between PCV10 serotypes and meningitis in IPD cases and penicillin and erythromycin resistance. The findings underscore the importance of continuous surveillance of serotypes and antimicrobial resistance patterns to inform treatment guidelines and vaccination policies. Further research is needed to assess the long-term impact of the PCV15 vaccine on serotype distribution and resistance.
侵袭性肺炎球菌病（IPD）的主要病因包括菌血症性肺炎、败血症和脑膜炎。肺炎球菌结合疫苗（PCV）的引入显著降低了由疫苗覆盖血清型引起的IPD发病率。然而，血清型替换和抗菌药物耐药性仍然令人担忧。在拉脱维亚，2010年肺炎球菌病疫苗接种被纳入国家免疫规划，使用的是PCV7，后来在2012年过渡到PCV10，并于2024年过渡到PCV15。本研究旨在确定拉脱维亚抗菌药物耐药性的变化及其与PCV10血清型的关联。
我们利用拉脱维亚11年期间（2012 - 2022年）的IPD监测数据进行了一项基于人群的横断面研究。IPD病例根据欧盟病例定义确定。对来自通常无菌部位的分离株进行血清型鉴定和抗菌药物敏感性测试。我们使用卡方检验分析IPD发病率、血清型分布和抗菌药物耐药性的差异，并使用多变量逻辑回归确定抗菌药物耐药性与危险因素之间的关联。
共报告了811例IPD病例，在整个研究期间观察到显著差异（<0.001）。最常见的血清型是3型和19A 型。多年来，由PCV10血清型引起的IPD病例比例显著下降，而由PCV13、PCV15和PPPV23血清型引起的病例增加。抗菌药物敏感性测试显示，青霉素耐药率为3.8%，红霉素耐药率为5.4%，头孢噻肟/头孢曲松耐药率为1.2%。红霉素耐药性随时间有显著变化（=0.016），从2012年的7.1%降至2022年的4.8%。多变量逻辑回归表明，PCV10血清型的IPD病例和脑膜炎与青霉素和红霉素耐药可能性增加显著相关。
该研究强调了IPD病例中红霉素耐药性随时间的下降，以及IPD病例中PCV10血清型和脑膜炎与青霉素和红霉素耐药性之间的显著关联。这些发现强调了持续监测血清型和抗菌药物耐药模式以指导治疗指南和疫苗接种政策的重要性。需要进一步研究评估PCV15疫苗对血清型分布和耐药性的长期影响。
