Pneumococcal carriage and antibiotic resistance in young children before 13-valent conjugate vaccine.
Pneumococcal carriage and antibiotic resistance in young children before 13-valent conjugate vaccine.
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DOI：
10.1097/inf.0b013e31824214ac
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发表时间：
2012-03
期刊：
影响因子：
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通讯作者：
Huang SS
中科院分区：
文献类型：
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作者：
Wroe PC;Lee GM;Finkelstein JA;Pelton SI;Hanage WP;Lipsitch M;Stevenson AE;Rifas-Shiman SL;Kleinman K;Dutta-Linn MM;Hinrichsen VL;Lakoma M;Huang SS
我们试图测量在广泛采用七价肺炎球菌结合疫苗（PCV 7）和引入13价肺炎球菌结合疫苗（PCV 13）之前，马萨诸塞州社区幼儿肺炎链球菌（SP）携带和抗生素耐药性的趋势。我们进行了一项横断面研究，包括在2008- 2009年冬季期间收集马萨诸塞州8个社区初级保健实践中7岁以下儿童的问卷数据和鼻咽标本，并与2001年、2003- 2004年和2006- 2007年进行的类似研究进行比较。对肺炎球菌分离株进行了抗菌药物敏感性测试和血清分型，并对最近几个季节（2006-07和2008-09）的定植风险因素进行了评估。我们收集了1,011名儿童的鼻咽标本，其中290名（29%）为肺炎球菌定植。非PCV 7血清型占肺炎球菌分离株的98%，最常见的是19 A（14%），6C（11%）和15 B/C（11%）。2008-09年，新靶向PCV 13血清型占携带分离株的20%和青霉素非敏感S的41%。肺炎链球菌（PNSP）。在多变量模型中，年龄小，儿童保育，年幼的兄弟姐妹，和上呼吸道疾病仍然是肺炎球菌携带的预测因子，尽管几乎完全的血清型替代。只有年轻和儿童保育与PNSP携带显着相关。PCV 7后的血清型替换基本上是完全的，并且在幼儿中持续存在，相对毒力的19 A是最常见的血清型。尽管血清型更换，但携带的预测因子仍然相似。PCV 13可能减少19 A和减少耐药菌株，但需要监测新血清型的替代。
We sought to measure trends in Streptococcus pneumoniae (SP) carriage and antibiotic resistance in young children in Massachusetts communities after widespread adoption of heptavalent pneumococcal conjugate vaccine (PCV7) and before the introduction of the 13-valent pneumococcal conjugate vaccine (PCV13). We conducted a cross-sectional study including collection of questionnaire data and nasopharyngeal specimens among children <7 years in primary care practices from 8 Massachusetts communities during the winter season of 2008–9 and compared with to similar studies performed in 2001, 2003–4, and 2006–7. Antimicrobial susceptibility testing and serotyping were performed on pneumococcal isolates, and risk factors for colonization in recent seasons (2006–07 and 2008–09) were evaluated. We collected nasopharyngeal specimens from 1,011 children, 290 (29%) of whom were colonized with pneumococcus. Non-PCV7 serotypes accounted for 98% of pneumococcal isolates, most commonly 19A (14%), 6C (11%), and 15B/C (11%). In 2008–09, newly-targeted PCV13 serotypes accounted for 20% of carriage isolates and 41% of penicillin non-susceptible S. pneumoniae (PNSP). In multivariate models, younger age, child care, young siblings, and upper respiratory illness remained predictors of pneumococcal carriage, despite near-complete serotype replacement. Only young age and child care were significantly associated with PNSP carriage. Serotype replacement post-PCV7 is essentially complete and has been sustained in young children, with the relatively virulent 19A being the most common serotype. Predictors of carriage remained similar despite serotype replacement. PCV13 may reduce 19A and decrease antibiotic-resistant strains, but monitoring for new serotype replacement is warranted.