invasive pneumococcal disease in children aged younger than 5 years in India: a surveillance study
invasive pneumococcal disease in children aged younger than 5 years in India: a surveillance study
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DOI：
10.1016/s1473-3099(16)30466-2
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发表时间：
2017-03-01
影响因子：
56.3
通讯作者：
Knoll, Maria Deloria
中科院分区：
文献类型：
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作者：
Manoharan, Anand;Manchanda, Vikas;Knoll, Maria Deloria
印度5岁以下儿童的背景侵入性肺炎球菌疾病仍然是发病率和死亡率的主要原因。我们的目的是为肺炎链球菌，侵入性肺炎球菌的血清型以及侵入性的肺炎球菌抗菌抗性模式提供全国代表性数据我们前瞻性地招募了5岁以下的儿童，该儿童来自18家医院或机构中心的可疑或证明的侵袭性肺炎球菌疾病，并回顾性地包括了来自十个前哨实验室的实验室确认的肺炎球菌分离株，共同代表印度11个州。资格标准的发烧高于38摄氏度，而没有局部症状，可疑脑膜炎或肺炎的临床表现以及射线照相肺炎的证据。我们培养血液和其他正常的无菌体液，重新确认和血清型性肺炎球菌分离株，并使用标准研究方案建立了抗菌敏感性。2011年1月1日至2015年6月30日之间的调查，我们招募了4377名患者。在361例（8％）患有培养的患者中，已知的所有临床数据均为226（63％）；在这些患者中，有132例（58％）出现肺炎，78例（35％）出现脑膜炎，16例（7％）具有其他临床状况。 131（3％）的总死亡，有29例（8％）患有侵袭性肺炎球菌病的患者死亡。血清型14（361中的52 [14％]，1（49 [14％]），5（37 [10％]）和19F（33 [9％]）是最常见的。青霉素在29例（8％）患者的分离株中发生了不敏感性，在239例（66％）中发生了三氧唑的耐药性，132例（37％）发生了红霉素的耐药性，氯霉素耐药性发生在33（9％）中。我们在361名患者中有33例（9％）发现了多药的耐药性。在研究的4。5年中，阳性血液培养物的比例，分离株的数量，地理代表和数据的比例代表了印度大多数地区的数据。有必要继续监视，因为决定在印度引入蛋白质共轭疫苗的决定。
Background Invasive pneumococcal disease continues to be a major cause of morbidity and mortality among children younger than 5 years of age in India. We aimed to provide nationally representative data for the pattern of disease due to Streptococcus pneumoniae, trends in the serotype of invasive pneumococci, and invasive pneumococci antimicrobial resistance patterns, in India.Methods In this prospective hospital-based and retrospective laboratory-based surveillance study, we prospectively enrolled children aged younger than 5 years with suspected or proven invasive pneumococcal disease from 18 hospitals or institutional centres and retrospectively included laboratory-confirmed pneumococcal isolates from ten sentinel laboratories, together representing 11 states in India. Eligibility criteria were fever higher than 38 degrees C without localising symptoms, clinical presentation of suspected meningitis or pneumonia, and evidence of radiographic pneumonia. We cultured blood and other normally sterile body fluids, reconfirmed and serotyped pneumococcal isolates, and established antimicrobial susceptibility using standard study protocols.Findings Between Jan 1, 2011, and June 30, 2015, we enrolled 4377 patients. Among 361 (8%) patients with culture proven pneumococcal disease, all clinical data were known for 226 (63%); among these patients, 132 (58%) presented with pneumonia, 78 (35%) presented with meningitis, and 16 (7%) had other clinical conditions. 131 (3%) died overall and 29 (8%) patients with invasive pneumococcal disease died. Serotypes 14 (52 [14%] of 361), 1 (49 [14%]), 5 (37 [10%]), and 19F (33 [9%]) were the most common. Penicillin non-susceptibility occurred in isolates from 29 (8%) patients, co-trimoxazole resistance occurred in 239 (66%), erythromycin resistance occurred in 132 (37%), and chloramphenicol resistance occurred in 33 (9%). We found multidrug resistance in 33 (9%) of 361 patients.Interpretation The proportion of positive blood cultures, number of isolates, geographical representation, and data generated over the 4.5 years of the study are representative of data for most of India. Continued surveillance is warranted as the decision to introduce protein conjugated vaccine in India is made.