Distribution of 13-Valent Pneumococcal Conjugate Vaccine Streptococcus pneumoniae Serotypes in US Adults Aged ≥50 Years With Community-Acquired Pneumonia
Distribution of 13-Valent Pneumococcal Conjugate Vaccine Streptococcus pneumoniae Serotypes in US Adults Aged ≥50 Years With Community-Acquired Pneumonia
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DOI：
10.1093/infdis/jit506
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发表时间：
2013-12-01
影响因子：
6.4
通讯作者：
File, Thomas M., Jr.
中科院分区：
文献类型：
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作者：
Sherwin, Robert L.;Gray, Sharon;File, Thomas M., Jr.
背景在美国，肺炎链球菌引起相当大比例的社区获得性肺炎（CAP）和医疗保健相关性肺炎（HCAP）。关于引起CAP和HCAP的肺炎球菌血清型的数据有限。对2010年2月至2011年9月期间在参与研究的美国医院就诊并经放射学证实的肺炎的年龄≥ 50岁的成人进行筛选，以纳入研究。S.使用微生物培养物BinaxNOW（R）S. pneumoniae测定或尿抗原检测（UAD）测定能够检测13价肺炎球菌结合疫苗（PCV 13）相关血清型。在入组的710例受试者中，中位年龄为65.4岁; 54.2%的受试者为男性，22.4%的影像学证实的肺炎病例被认为是HCAP，96.6%的受试者住院。S.在98例受试者（13.8%）中通过任何测试检测到肺炎，在78例受试者（11.0%）中通过UAD鉴定出PCV 13相关血清型。血清型19 A最普遍，其次是7 F/A、3和5。与7价肺炎球菌结合疫苗（PCV 7）相关的血清型占UAD阳性分离株的25%。在成人中引起非侵袭性肺炎的肺炎球菌血清型可能与引起侵袭性疾病的血清型显著不同，其中PCV 7相关血清型过多。血清5型，在美国的侵袭性疾病的当代监测中很少见到，在很大程度上促成了所观察到的S。肺炎阳性CAP或HCAP。
Background. Streptococcus pneumoniae causes a substantial proportion of community-acquired pneumonia (CAP) and healthcare-associated pneumonia (HCAP) in the United States. Limited data are available regarding the pneumococcal serotypes causing CAP and HCAP.Methods. Adults aged >= 50 years presenting to participating US hospitals with radiographically confirmed pneumonia between February 2010 and September 2011 were screened for inclusion. S. pneumoniae was identified using microbiological cultures, BinaxNOW (R) S. pneumoniae assay, or urine antigen detection (UAD) assay capable of detecting 13-valent pneumococcal conjugate vaccine (PCV13)-associated serotypes.Results. Among 710 subjects enrolled, the median age was 65.4 years; 54.2% of subjects were male, 22.4% of radiographically confirmed pneumonia cases were considered HCAP, and 96.6% of subjects were hospitalized. S. pneumoniae was detected in 98 subjects (13.8%) by any test, and PCV13-associated serotype(s) were identified by UAD in 78 (11.0%). Serotype 19A was most prevalent, followed by 7F/A, 3, and 5. Serotypes associated with 7-valent pneumococcal conjugate vaccine (PCV7) accounted for 25% of UAD-positive isolates.Conclusions. Pneumococcal serotypes causing noninvasive pneumonia in adults may differ significantly from those causing invasive disease, with PCV7-associated serotypes overrepresented. Serotype 5, rarely seen in contemporary surveillance of invasive disease in the United States, substantially contributed to the observed cases of S. pneumoniae-positive CAP or HCAP.