Community-acquired Invasive Bacterial Disease in Urban Gambia, 2005-2015: A Hospital-based Surveillance
Community-acquired Invasive Bacterial Disease in Urban Gambia, 2005-2015: A Hospital-based Surveillance
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DOI：
10.1093/cid/ciz463
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发表时间：
2019-09-15
影响因子：
11.8
通讯作者：
Roca, Anna
中科院分区：
文献类型：
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作者：
Darboe, Saffiatou;Okomo, Uduak;Roca, Anna
背景侵入性细菌疾病在撒哈拉以南非洲造成重大疾病和死亡。有些是疫苗可预防的，尽管由于监测数据有限，人们对新疫苗和疫苗政策对这些社区疾病模式的影响知之甚少。我们在冈比亚进行了一项以医院为基础的侵入性细菌性疾病监测，对住院参与者的血液和脑脊液（CSF）样本进行了处理。针对引入肺炎球菌结合疫苗（PCV），定义了三个监测期，即PCV引入之前（2005-2009年）、期间（2010-2011年）和之后（2012-2015年）。对不同监测期常见细菌的检出率进行比较。在11年内共采集了14 715份血液和1103份CSF样本;总体而言，从957例患者中分离出1045种具有临床意义的微生物（972种微生物[6.6%]来自血液，73种[6.6%]来自CSF）。最常见的血培养分离株为肺炎链球菌（24.9%）、金黄色葡萄球菌（22.0%）、大肠埃希菌（10.9%）和非伤寒沙门氏菌（10.0%）。在PCV前后，S.肺炎菌血症在所有年龄组均下降（从32.4%降至16.5%;比值比，0.41; 95%置信区间，0.29 - 0.58），而S.金黄色葡萄球菌的患病率上升，成为最常见的细菌（从16.9%到27.2%; 1.75; 1.26-2.44）。总体而言，S.肺炎奈瑟菌（53.4%）、脑膜炎奈瑟菌（13.7%）和流感嗜血杆菌（12.3%）是脑脊液中的主要分离株。对常用抗生素耐药率低。我们的研究结果表明，与侵袭性疾病相关的主要病原体的监测数据是必要的，以告知疫苗的优先顺序和适当的患者管理。
Background. Invasive bacterial diseases cause significant disease and death in sub-Saharan Africa. Several are vaccine preventable, although the impact of new vaccines and vaccine policies on disease patterns in these communities is poorly understood owing to limited surveillance data.Methods. We conducted a hospital-based surveillance of invasive bacterial diseases in The Gambia where blood and cerebrospinal fluid (CSF) samples of hospitalized participants were processed. Three surveillance periods were defined in relation to the introduction of pneumococcal conjugate vaccines (PCVs), before (2005-2009), during (2010-2011) and after (2012-2015) PCV introduction. We determined the prevalences of commonly isolated bacteria and compared them between the different surveillance periods.Results. A total of 14 715 blood and 1103 CSF samples were collected over 11 years; overall, 1045 clinically significant organisms were isolated from 957 patients (972 organisms [6.6%] from blood and 73 [6.6%] from CSF). The most common blood culture isolates were Streptococcus pneumoniae (24.9%), Staphylococcus aureus (22.0%), Escherichia coli (10.9%), and nontyphoidal Salmonella (10.0%). Between the pre-PCV and post-PCV eras, the prevalence of S. pneumoniae bacteremia dropped across all age groups (from 32.4% to 16.5%; odds ratio, 0.41; 95% confidence interval, .29-.58) while S. aureus increased in prevalence, becoming the most prevalent bacteria (from 16.9% to 27.2%; 1.75; 1.26-2.44). Overall, S. pneumoniae (53.4%), Neisseria meningitidis (13.7%), and Haemophilus influenzae (12.3%) were the predominant isolates from CSF. Antimicrobial resistance to common antibiotics was low.Conclusions. Our findings demonstrate that surveillance data on the predominant pathogens associated with invasive disease is necessary to inform vaccine priorities and appropriate management of patients.