High Nasopharyngeal Pneumococcal Density, Increased by Viral Coinfection, Is Associated With Invasive Pneumococcal Pneumonia
High Nasopharyngeal Pneumococcal Density, Increased by Viral Coinfection, Is Associated With Invasive Pneumococcal Pneumonia
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DOI：
10.1093/infdis/jiu326
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发表时间：
2014-11-15
影响因子：
6.4
通讯作者：
von Gottberg, Anne
中科院分区：
文献类型：
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作者：
Wolter, Nicole;Tempia, Stefano;von Gottberg, Anne
背景我们确定了急性下呼吸道感染（ALRTI）住院患者中肺炎球菌定植、高定植密度和侵袭性肺炎球菌肺炎的相关因素。2010年，南非监测登记了4025例病例。共969 4025系统选择鼻咽口咽标本（24%）进行了检测呼吸道病毒和肺炎链球菌的实时聚合酶链反应。其中，749人（77%）进行了血液检测S。pneumoniae.Results.在55%的病例（534/969）中检测到肺炎球菌定植。控制年龄、结核病治疗、流感病毒感染的多因素分析（调整的比值比[OR]，2.2; 95%置信区间[CI]，1.1-4.5），腺病毒（校正OR，1.7; 95% CI，1.1-2.7），鼻病毒（调整后OR，1.6; 95%CI，1.1-2.3）和人类免疫缺陷病毒（HIV;调整后OR，1.6; 95%CI，1.1-2.4）与肺炎球菌定植相关。经年龄和性别校正后，高定植密度与呼吸道病毒合并感染（校正OR，1.7; 95%CI，1.1-2.6）和侵袭性肺炎球菌肺炎（校正OR，2.3; 95%CI，1.3-4.0）相关。7%（749人中的52人）在血液中检测到肺炎球菌。对定植病例进行多变量分析，侵袭性肺炎球菌肺炎与HIV相关（校正OR，3.2; 95% CI，1.4-7.5），流感病毒（校正OR，8.2; 95% CI，2.7-25.0），高定植密度（调整后OR，18.7; 95%CI，2.3-155.1），住院时间≥ 5天（调整后OR，3.7; 95%CI，1.7-8.2）。呼吸道病毒感染与定植密度升高相关，进而与侵袭性肺炎球菌肺炎相关。
Background. We identified factors associated with pneumococcal colonization, high colonization density, and invasive pneumococcal pneumonia among patients hospitalized with acute lower respiratory tract infections (ALRTIs).Methods. In 2010, 4025 cases were enrolled in surveillance in South Africa. A total of 969 of 4025 systematically selected nasopharyngeal-oropharyngeal specimens (24%) were tested for respiratory viruses and Streptococcus pneumoniae by real-time polymerase chain reaction. Of these, 749 (77%) had blood tested for S. pneumoniae.Results. Pneumococcal colonization was detected in 55% of cases (534 of 969). On multivariable analysis that controlled for age and tuberculosis treatment, infection with influenza virus (adjusted odds ratio [OR], 2.2; 95% confidence interval [CI], 1.1-4.5), adenovirus (adjusted OR, 1.7; 95% CI, 1.1-2.7), rhinovirus (adjusted OR, 1.6; 95% CI, 1.1-2.3), and human immunodeficiency virus (HIV; adjusted OR, 1.6; 95% CI, 1.1-2.4) were associated with pneumococcal colonization. High colonization density was associated with respiratory virus coinfection (adjusted OR, 1.7; 95% CI, 1.1-2.6) and invasive pneumococcal pneumonia (adjusted OR, 2.3; 95% CI, 1.3-4.0), after adjustment for age and sex. Seven percent (52 of 749) had pneumococci detected in blood. On multivariable analysis among colonized cases, invasive pneumococcal pneumonia was associated with HIV (adjusted OR, 3.2; 95% CI, 1.4-7.5), influenza virus (adjusted OR, 8.2; 95% CI, 2.7-25.0), high colonization density (adjusted OR, 18.7; 95% CI, 2.3-155.1), and >= 5 days of hospitalization (adjusted OR, 3.7; 95% CI, 1.7-8.2).Conclusions. Respiratory virus infection was associated with elevated colonization density and, in turn, invasive pneumococcal pneumonia.