Changes in the incidence and bacterial aetiology of paediatric parapneumonic pleural effusions/empyema in Germany, 2010-2017: a nationwide surveillance study
Changes in the incidence and bacterial aetiology of paediatric parapneumonic pleural effusions/empyema in Germany, 2010-2017: a nationwide surveillance study
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DOI：
10.1016/j.cmi.2018.10.020
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发表时间：
2019-07-01
影响因子：
14.2
通讯作者：
Streng, A.
中科院分区：
文献类型：
--
作者：
Liese, J. G.;Schoen, C.;Streng, A.
目的：胸膜旁胸腔积液/脓胸（PPE/PE）是社区获得性肺炎的严重并发症。我们调查了细菌病原学和发病率的儿科PPE/PE在德国后，引入通用肺炎球菌结合疫苗（PCV）immunization for infants. Methods：儿童7天的报告，德国监测单位在2010年10月和2017年6月之间的罕见疾病的儿童。所有的细菌检测血液或胸腔积液（培养/PCR），包括肺炎链球菌血清分型。结果：所有1447 PPE/PE患者的中位年龄为5岁（四分位数范围3 - 10）。在1447名PPE/PE儿童中的488名（34%）中，检测到541种细菌（> 40种）。需氧革兰氏阳性球菌占检出的541种细菌中的469种（87%）;最常见的是肺炎链球菌（41%）、化脓性链球菌（19%）和金黄色葡萄球菌（6%）。在78株血清型中，3型占45%。pneumoniae菌株PPE/PE年发病率在每百万儿童14（95%CI 12 - 16）和18（95%CI 16 - 21）PPE/PE之间变化。S的发病率。肺炎患者PPE/PE从3.5（95%CI 2.5 - 4.6）从2010/11年度的每百万儿童1.5 2013/14年度（95%CI 0.9 - 2.4）（p 0.002），随后再次增加至2.2（95%CI 1.5 - 3.2）（p 0.205）。结论：在PCV广泛免疫的时代，儿科PPE/PE病例仍主要由S. pneumoniae和越来越多的S.化脓PPE/PE的发病率总体和S.肺炎相关PPE/PE表明细菌病因学正在发生变化，需要进一步监测。(C)2018作者由Elsevier Ltd代表欧洲临床微生物学和传染病学会出版。
Objectives: Parapneumonic pleural effusions/empyema (PPE/PE) are severe complications of community-acquired pneumonia. We investigated the bacterial aetiology and incidence of paediatric PPE/PE in Germany after the introduction of universal pneumococcal conjugate vaccine (PCV) immunization for infants.Methods: Children 7 days were reported to the German Surveillance Unit for Rare Diseases in Childhood between October 2010 and June 2017. All bacteria detected in blood or pleural fluid (by culture/PCR) were included, with serotyping for Streptococcus pneumoniae.Results: The median age of all 1447 PPE/PE patients was 5 years (interquartile range 3-10). In 488 of the 1447 children with PPE/PE (34%), 541 bacteria (>40 species) were detected. Aerobic gram-positive cocci accounted for 469 of 541 bacteria detected (87%); these were most frequently Streptococcus pneumoniae (41%), Streptococcus pyogenes (19%) and Staphylococcus aureus (6%). Serotype 3 accounted for 45% of 78 serotyped S. pneumoniae strains. Annual PPE/PE incidence varied between 14 (95%CI 12-16) and 18 (95%CI 16-21) PPE/PE per million children. Incidence of S. pneumoniae PPE/PE decreased from 3.5 (95%CI 2.5-4.6) per million children in 2010/11 to 1.5 (95%CI 0.9-2.4) in 2013/14 (p 0.002), followed by a reincrease to 2.2 (95%CI 1.5-3.2) by 2016/17 (p 0.205).Conclusions: In the era of widespread PCV immunization, cases of paediatric PPE/PE were still caused mainly by S. pneumoniae and, increasingly, by S. pyogenes. The re-increase in the incidence of PPE/PE overall and in S. pneumoniae-associated PPE/PE indicates ongoing changes in the bacterial aetiology and requires further surveillance. (C) 2018 The Authors. Published by Elsevier Ltd on behalf of European Society of Clinical Microbiology and Infectious Diseases.