高价值肺炎球菌联合疫苗对殖民和急性中耳炎的预期影响
Ravinder Kaur1, Steven Schulz1, Andrew Sherman1
1From the Center for Infectious Diseases and Immunology, Rochester General Hospital Research Institute, Rochester, New York.
The Pediatric infectious disease journal
|June 5, 2024
概括
高性肺炎球菌合疫苗 (PCV) 可能对急性中耳炎 (AOM) 的影响有限,因为非PCV15/20血清型,如35B,占主导地位. 血球流感仍然是一个常见的AOM病原体,需要更新的抗生素策略.
科学领域:
- 儿童传染病 儿童传染病
- 微生物学 微生物学
- 疫苗学 疫苗学 疫苗学
背景情况:
- 急性中耳炎 (AOM) 的细菌病因因肺炎球菌合疫苗 (PCV) 和抗生素使用而演变.
- 鉴别关键的耳病原体,如肺炎性链球菌 (Spn),流感性血球菌 (Hflu) 和Moraxella catarrhalis (Mcat),对于理解AOM转变至关重要.
研究的目的:
- 在儿童的鼻和中耳液 (MEF) 中表征Spn,Hflu和Mcat.
- 评估高价值PCVs (PCV15和PCV20) 对AOM细菌概况的潜在影响.
主要方法:
- 对6-36个月龄的PCV13免疫儿童进行前性纵向队列研究 (2021年9月至2023年9月).
- 通过 tympanocentesis收集鼻和MEF样本.
- 对Spn,Hflu和Mcat分离物的血型定型和抗生素敏感性测试.
主要成果:
- 在MEF中,Hflu是主要的耳病原体,而Mcat和Spn在鼻殖民中更为频繁.
- 非PCV15和非PCV20 Spn血清型,特别是35B血清型,在鼻和MEF分离物中均普遍存在.
- 观察到显著的抗生素耐药性:30%的Spn,23%的Hflu对阿莫西西林不敏感,100%的Mcat分离物产生β-乳糖酶.
结论:
- 高价值的PCVs (PCV15,PCV20) 可能对减少肺炎球菌殖民和AOM的影响有限,因为非疫苗血清型占主导地位.
- 在AOM中,H. influenzae仍然是主要的病原体.
- 目前的抗生素耐药性模式表明,需要高剂量的阿莫西林/克拉夫兰酸盐或替代实证治疗来进行最佳的AOM管理.
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