Risk modelling the mortality impact of antimicrobial resistance in secondary pneumococcal pneumonia infections during the 2009 influenza pandemic
Risk modelling the mortality impact of antimicrobial resistance in secondary pneumococcal pneumonia infections during the 2009 influenza pandemic
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DOI：
10.1016/j.ijid.2019.05.005
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发表时间：
2019-08-01
影响因子：
8.4
通讯作者：
MacIntyre, C. Raina
中科院分区：
文献类型：
--
作者：
Barnes, Carrie E.;MacIntyre, C. Raina
目的：本研究的目的是评估 2009 年流感大流行期间继发性肺炎球菌肺炎感染中的抗菌素耐药性 (AMR) 对全球死亡率的影响，估计未来大流行死亡风险并为大流行防范提供信息。方法：使用多变量风险公式进行风险分析模型。通过文献综述，对与 2009 年流感大流行、继发性肺炎球菌肺炎、AMR 发生率和作为大流行防范组成部分的肺炎球菌疫苗功效相关的风险公式的每个参数进行全球中心估计。结果：全球肺炎链球菌 AMR 估计为 21.8% 至 27.6%，并导致 2009 年流感大流行期间死亡人数的 1.8% 至 2.3%。当直接应用于多重耐药导致的死亡率时，肺炎球菌疫苗接种可潜在预防 1277 至 3754 例死亡，并将多重耐药肺炎链球菌死亡率降低至 1% 至 1.2%。结论：继发性肺炎球菌感染中的 AMR 只占 2009 年流感大流行期间全球死亡率的一小部分。肺炎链球菌 AMR 的增加可能会导致未来流感大流行中继发性肺炎球菌感染导致的死亡率增加三到四倍。肺炎球菌疫苗接种对于预防所有人群的肺炎球菌合并感染和对抗抗菌素耐药性具有重要作用，应被视为流感大流行防范或早期行动计划的关键组成部分。 (C) 2019 年作者。由爱思唯尔有限公司代表国际传染病学会出版。
Objectives: The aim of this study was to estimate the impact of antimicrobial resistance (AMR) in secondary pneumococcal pneumonia infections on global mortality during the 2009 influenza pandemic, to estimate future pandemic mortality risk and to inform pandemic preparedness.Methods: Risk analysis modelling was conducted using a multivariate risk formula. Literature reviews were conducted to generate global central estimates for each of the parameters of the risk formula in relation to the 2009 influenza pandemic, secondary pneumococcal pneumonia, rates of AMR, and pneumococcal vaccine efficacy as a component of pandemic preparedness.Results: Global Streptococcus pneumoniae AMR was estimated at 21.8% to 27.6%, and contributed to 1.8% to 2.3% of deaths during the 2009 influenza pandemic. When directly applied to mortality due to multidrug resistance, pneumococcal vaccination could potentially prevent 1277 to 3754 deaths and could have reduced mortality from multidrug-resistant S. pneumoniae to 1% to 1.2%.Conclusions: AMR in secondary pneumococcal infections contributed towards a small percentage of the global mortality during the 2009 influenza pandemic. Increased S. pneumoniae AMR could result in a three- to four-fold rise in mortality due to secondary pneumococcal infections in future influenza pandemics. Pneumococcal vaccination has an important role in preventing pneumococcal co-infections and combating AMR in all populations, and should be considered a key component of influenza pandemic preparedness or early action plans. (C) 2019 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.