未接种疫苗的养老院居民中发生耐多药肺炎球菌肺炎和菌血症疫情。

An outbreak of multidrug-resistant pneumococcal pneumonia and bacteremia among unvaccinated nursing home residents.

作者信息

Nuorti J P, Butler J C, Crutcher J M, Guevara R, Welch D, Holder P, Elliott J A

机构信息

Epidemiology Program Office, Respiratory Diseases Branch, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.

出版信息

N Engl J Med. 1998 Jun 25;338(26):1861-8. doi: 10.1056/NEJM199806253382601.

DOI:10.1056/NEJM199806253382601

PMID:9637804

Abstract

BACKGROUND

Outbreaks of pneumococcal disease are uncommon and have occurred mainly in institutional settings. Epidemic, invasive, drug-resistant pneumococcal disease has not been seen among adults in the United States. In February 1996, there was an outbreak of multidrug-resistant pneumococcal pneumonia among the residents of a nursing home in rural Oklahoma.

METHODS

We obtained nasopharyngeal swabs for culture from residents and employees. Streptococcus pneumoniae isolates were serotyped and compared by pulsed-field gel electrophoresis. A retrospective cohort study was conducted to identify factors associated with colonization and disease.

RESULTS

Pneumonia developed in 11 of 84 residents (13 percent), 3 of whom died. Multidrug-resistant S. pneumoniae, serotype 23F, was isolated from blood and sputum from 7 of the 11 residents with pneumonia (64 percent) and from nasopharygeal specimens from 17 of the 74 residents tested (23 percent) and 2 of the 69 employees tested (3 percent). All the serotype 23F isolates were identical according to pulsed-field gel electrophoresis. Recent use of antibiotics was associated with both colonization (relative risk, 2.3; 95 percent confidence interval, 1.3 to 4.2) and disease (relative risk, 3.6; 95 percent confidence interval, 1.2 to 10.8). Only three residents (4 percent) had undergone pneumococcal vaccination. After residents received pneumococcal vaccine and prophylactic antibiotics, there were no additional cases of pneumonia, and the rates of carriage decreased substantially.

CONCLUSIONS

In this outbreak a single pneumococcal strain was disseminated among the residents and employees of a nursing home. The high prevalence of colonization with a virulent organism in an unvaccinated population contributed to the high attack rate. Clusters of pneumococcal disease may be underrecognized in nursing homes, and wider use of pneumococcal vaccine is important to prevent institutional outbreaks of drug-resistant S. pneumoniae infection.

摘要

背景

肺炎球菌疾病的暴发并不常见，主要发生在机构环境中。在美国成年人中尚未出现流行性、侵袭性、耐药性肺炎球菌疾病。1996年2月，俄克拉何马州农村一家疗养院的居民中暴发了多重耐药性肺炎球菌肺炎。

方法

我们从居民和员工中采集鼻咽拭子进行培养。对肺炎链球菌分离株进行血清分型，并通过脉冲场凝胶电泳进行比较。开展了一项回顾性队列研究，以确定与定植和疾病相关的因素。

结果

84名居民中有11人（13%）发生肺炎，其中3人死亡。在11例肺炎居民中，有7人（64%）的血液和痰液中分离出多重耐药性23F型肺炎链球菌，在74名接受检测的居民中，有17人（23%）的鼻咽标本中分离出该菌，在69名接受检测的员工中，有2人（3%）的鼻咽标本中分离出该菌。根据脉冲场凝胶电泳，所有23F型分离株均相同。近期使用抗生素与定植（相对危险度，2.3；95%可信区间，1.3至4.2）和疾病（相对危险度，3.6；95%可信区间，1.2至10.8）均相关。只有3名居民（4%）接种过肺炎球菌疫苗。居民接种肺炎球菌疫苗并使用预防性抗生素后，未再出现肺炎病例，带菌率大幅下降。