High incidence of septic shock caused by Streptococcus pneumoniae serotype 3--a retrospective epidemiological study.
High incidence of septic shock caused by Streptococcus pneumoniae serotype 3--a retrospective epidemiological study.
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DOI：
10.1186/1471-2334-13-492
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发表时间：
2013-10-22
影响因子：
3.7
通讯作者：
Riesbeck K
中科院分区：
文献类型：
--
作者：
Ahl J;Littorin N;Forsgren A;Odenholt I;Resman F;Riesbeck K
肺炎链球菌存在 90 多种免疫学上不同的血清型，尚未完全阐明该血清型是否是侵袭性肺炎球菌疾病 (IPD) 严重程度的危险因素。我们的假设是，血清型引起感染性休克的能力不同。我们在瑞典南部对 2006 年至 2008 年疫苗前时代的 513 名 IPD 患者进行了一项回顾性研究。确定血清型、合并症和脓毒症严重程度。将血清型与作为参考的血清型 14 进行比较，并根据其侵袭潜力进行分组，即高（血清组 1、5 和 7）、中（血清组 4、9、14 和 18）、最后是低侵袭潜力（血清组 3、6、8、15、19、23 和 33）。肺炎链球菌血清型 3 患者明显更常见败血性休克（25%，比值比 (OR) 6.33 [95% 置信区间 (CI) 1.59-25.29]）、更高死亡率（30%，OR 2.86 [CI 1.02-8.00]），并且更常见合并症（83%，OR 3.82 [CI]） 1.39-10.54]）与血清型14相比。根据感染性肺炎球菌的侵袭潜力汇总患者数据时，发现年龄和合并症存在显着差异（p≤0.001）。对于低侵袭性血清群，患有潜在合并症的患者的中位年龄和百分比分别为 72 岁和 79%，对于中等侵袭性血清群，分别为 68 岁和 61%，最后，对于高侵袭性血清群，分别为 62 岁和 48%。三组之间脓毒症严重程度没有差异。与血清型 14 相比，肺炎链球菌血清型 3 更容易引起感染性休克。我们的结果支持这样的假设：高侵袭性血清型主要导致合并症较少的年轻患者 IPD。相比之下，具有低和中等侵袭潜力的血清群主要导致具有明确合并症的老年人的IPD，因此可以被认为是机会性的。
More than 90 immunologically distinct serotypes of Streptococcus pneumoniae exist, and it is not fully elucidated whether the serotype is a risk factor for severity of invasive pneumococcal disease (IPD). Our hypothesis is that serotypes differ in their capacity to cause septic shock. We performed a retrospective study in Southern Sweden based upon 513 patients with IPD in the pre-vaccine era 2006–2008. The serotype, co-morbidity, and sepsis severity were determined. Serotypes were compared to serotype 14 as a reference and grouped according to their invasive potential, that is, high (serogroups 1, 5 and 7), intermediate (serogroups 4, 9, 14 and 18) and, finally, low invasive potential (serogroups 3, 6, 8, 15, 19, 23 and 33). Patients with S. pneumoniae serotype 3 had significantly more often septic shock (25%, odds ratio (OR) 6.33 [95% confidence interval (CI) 1.59-25.29]), higher mortality (30%, OR 2.86 [CI 1.02-8.00]), and more often co-morbidities (83%, OR 3.82 [CI 1.39-10.54]) when compared to serotype 14. A significant difference in age and co-morbidities (p≤0.001) was found when patient data were pooled according to the invasive potential of the infecting pneumococci. The median age and percentage of patients with underlying co-morbidities were 72 years and 79%, respectively, for serogroups associated with low invasiveness, 68 years and 61%, respectively, for serogroups with intermediate invasiveness, and, finally, 62 years and 48%, respectively, for serogroups with high invasiveness. No difference in sepsis severity was found between the three groups. S. pneumoniae serotype 3 more often caused septic shock compared to serotype 14. Our results support the hypothesis that serotypes with high invasiveness mainly cause IPD in younger patients with less co-morbidities. In contrast, serogroups with low and intermediate invasive potential mostly cause IPD in the elderly with defined co-morbidities, and thus can be considered as opportunistic.
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