Pneumococcal colonisation density: a new marker for disease severity in HIV-infected adults with pneumonia
Pneumococcal colonisation density: a new marker for disease severity in HIV-infected adults with pneumonia
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DOI：
10.1136/bmjopen-2014-005953
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发表时间：
2014-01-01
期刊：
影响因子：
2.9
通讯作者：
Klugman, Keith P.
中科院分区：
文献类型：
--
作者：
Albrich, Werner C.;Madhi, Shabir A.;Klugman, Keith P.
目的：来自血液或脑脊液的高基因组负荷肺炎球菌与死亡率增加有关。我们的目的是分析hiv感染的社区获得性肺炎（CAP）患者的鼻咽定植密度是否与疾病严重程度或不良结局标志物相关。方法：对南非索韦托Chris Hani Baragwanath医院因急性CAP住院的hiv感染南非成年人的鼻咽拭子进行定量lytA实时荧光定量PCR检测。痰培养或革兰氏染色、尿中肺炎球菌c -多糖抗原、血培养或全血lytA实时荧光定量PCR均提示肺炎球菌。结果：全因肺炎患者的平均鼻咽部定植密度与CURB65评分升高（Spearman相关系数r=0.15, p=0.06）或肺炎球菌菌血症患者的Pitt菌血症评分升高（p=0.63）存在中等相关性。在肺炎球菌肺炎患者中，非幸存者的鼻咽肺炎球菌定植密度高于幸存者（分别为7.7对6.1 log（10）拷贝/mL， p=0.02），而通过血培养和/或全血lytA实时PCR鉴定出肺炎球菌的患者的鼻咽肺炎球菌定植密度高于非细菌性肺炎球菌肺炎患者（6.6对5.6 log（10）拷贝/mL， p=0.03）。鼻咽定植密度与生物标志物降钙素原呈正相关(Spearman相关系数r=0.37, p
Objective: A high genomic load of Pneumococcus from blood or cerebrospinal fluid has been associated with increased mortality. We aimed to analyse whether nasopharyngeal colonisation density in HIV-infected patients with community-acquired pneumonia (CAP) is associated with markers of disease severity or poor outcome.Methods: Quantitative lytA real-time PCR was performed on nasopharyngeal swabs in HIV-infected South African adults hospitalised for acute CAP at Chris Hani Baragwanath Hospital, Soweto, South Africa. Pneumonia aetiology was considered pneumococcal if any sputum culture or Gram stain, urinary pneumococcal C-polysaccharide-based antigen, blood culture or whole blood lytA real-time PCR revealed pneumococci.Results: There was a moderate correlation between the mean nasopharyngeal colonisation densities and increasing CURB65 scores among all-cause patients with pneumonia (Spearman correlation coefficient r=0.15, p=0.06) or with the Pitt bacteraemia score among patients with pneumococcal bacteraemia (p=0.63). In patients with pneumococcal pneumonia, nasopharyngeal pneumococcal colonisation density was higher among non-survivors than survivors (7.7 vs 6.1 log(10) copies/mL, respectively, p=0.02) and among those who had pneumococci identified from blood cultures and/or by whole blood lytA real-time PCR than those with non-bacteraemic pneumococcal pneumonia (6.6 vs 5.6 log(10) copies/mL, p=0.03). Nasopharyngeal colonisation density correlated positively with the biomarkers procalcitonin (Spearman correlation coefficient r=0.37, p