Pneumococcal conjugate vaccine against serotype 3 pneumococcal pneumonia in adults: A systematic review and pooled analysis

BackgroundSerotype 3 pneumococcal disease has not substantially declined at the population level after the routine introduction of 13-valent pneumococcal conjugate vaccine (PCV13) into pediatric immunization programs across the globe. This epidemiological finding has generated debate regarding the effectiveness of PCV13 against serotype 3 disease. Evaluating PCV13 effectiveness against serotype 3 is especially critical in adults, where serotype 3 makes up an important amount of remaining pneumococcal disease.MethodsWe performed a systematic review of the published literature to assess the direct effectiveness of PCV13 against serotype 3 community-acquired pneumonia (CAP) among adults. We then estimated overall vaccine effectiveness (VE) using a pooled analysis of the individual-level, raw data.ResultsTwo published studies met inclusion criteria. One was a randomized controlled trial conducted in the Netherlands and published in 2014. The other was a recently-published case-control study conducted in Louisville, Kentucky that used a test-negative design (TND). We also identified a third TND study conducted in Argentina that was recently presented as a conference abstract but is not yet published. All three studies were conducted in adults aged ≥65 years. PCV13 VE against serotype 3 hospitalized CAP was 52.5% (95%CI: 6.2–75.9%) from the pooled analysis of individual-level data from all three studies. Results were similar if the unpublished estimate was excluded (serotype 3 VE = 53.6% [95%CI: 6.7–76.9%]). No heterogeneity was observed.ConclusionsCurrently-available evidence, although limited to three studies, suggests that PCV13 provides direct protection against serotype 3 hospitalized CAP in adults aged ≥65 years.     

小儿肺热咳喘口服液治疗急性社区获得性下呼吸道感染临床观察

目的：观察小儿肺热咳喘口服液治疗小儿急性社区获得性下呼吸道感染的临床疗效及毒副作用。方法：我科门诊或住院确诊的小儿下感150例，随机分为治疗组100例，对照组50例，两组均进行常规抗感染治疗，治疗组加服小儿肺热咳喘口服液。对照组用百部止咳糖浆。结果：治疗组总显效率92．0％。显著优于对照组的78．0％（P〈0．01），在退热、止咳、消除啰音方面治疗组均优于对照组（P均〈0．05）。未见明显不良反应。结论：小儿肺热咳喘口服液治疗急性下呼吸道感染疗效好，无毒副作用。     

咽拭子、肺泡灌洗液肺炎支原体-DNA 水平与社区获得性肺炎支原体肺炎炎性反应及免疫功能的关系

目的探究咽拭子、肺泡灌洗液肺炎支原体-DNA(MP-DNA)水平与社区获得性肺炎支原体肺炎(CA-MPP)病儿病情、炎性反应及免疫功能指标的关系。方法选取2018年1月至2019年5月南阳市中心医院收治的92例CA-MPP病儿作为研究对象,对比重症组(n=30)与轻症组(n=62)病儿咽拭子、肺泡灌洗液MP-DNA水平。根据咽拭子、肺泡灌洗液MP-DNA水平分为低菌量组、中菌量组、高菌量组,比较三组血清炎性反应因子［C反应蛋白(CRP)、白细胞介素-18(IL-18)、肿瘤坏死因子-α(TNF-α)］水平、免疫功能指标［免疫球蛋白A(IgA)、IgM、IgG］水平,分析咽拭子、肺泡灌洗液MP-DNA与炎性反应、免疫功能指标的相关性。结果重症病儿咽拭子［(5.68±0.73)比(5.14±0.51)］、肺泡灌洗液MP-DNA水平［(6.87±0.85)比(5.70±0.63)］高于轻症病儿(P<0.05);咽拭子、肺泡灌洗液MP-DNA高菌量组血清CRP、TNF-α、IL-18水平高于中菌量组、低菌量组(P<0.05);咽拭子、肺泡灌洗液MP-DNA表达量与CA-MPP病儿血清CRP、TNF-α、IL-18水平存在显著正相关关系(P<0.05);咽拭子、肺泡灌洗液MP-DNA高菌量组血清IgA低于中菌量组、低菌量组,IgM、IgG高于中菌量组、低菌量组(P<0.05);咽拭子、肺泡灌洗液MP-DNA表达量与CA-MPP病儿血清IgA水平存在显著负相关关系,与血清IgM、IgG水平存在显著正相关关系(P<0.05)。结论咽拭子、肺泡灌洗液MP-DNA水平随着CA-MPP病儿病情加重而升高,且与病儿炎性反应、免疫功能存在密切相关性,监测其水平有助于临床明确病儿病情,指导合理治疗方案的制定。     

Incidence of all-cause adult community-acquired pneumonia in primary care settings in France

Objectives

To estimate the incidence of all-cause outpatient community-acquired pneumonia (CAP) in adults in France from a national prospective observational study of CAP management in general practice (CAPA).

医院与社区多药耐药菌感染特点分析

目的 了解医院获得性(HAP)与社区获得性(CAP)多药耐药菌(MDROs)感染特点,为临床有针对性地采取治疗及控制措施提供科学依据.方法 对医院2008年6月-2009年5月住院患者发牛金黄色葡萄球菌、肠球菌属、鲍氏不动杆菌、大肠埃希菌及肺炎克雷伯菌感染者进行调查,分析多药耐药菌感染的特点.结果 共调查感染病例929例次,MDROs感染检出率为39.5%;HAP-MDROs及CAP-MDROs感染检出率分别是51.4%及35.6%,HAP-MDROs感染显著高于CAP-MDROs感染(X~2=19.2 P=0.00);CAP-MDROs占MDROs检出总数的64.0%;不同科室HAP-MDROs及CAP-MDROs感染分布存在一定差异;不同MDROs来源不同,MRSA、产ESBLs肺炎克雷伯菌及PDR-AB主要来源于痰或气管分泌物;产ESBLs大肠埃希菌主要来源于社区感染的泌尿生殖道标本.结论 了解HAP-MDROs及CAP-MDROs感染特点,对于细菌感染性疾病的治疗及经验选用抗菌药物具有重要的参考意义;CAP-MDROs感染检出率高使MDROs控制难度增加.     

儿童社区获得性肺炎病原学研究进展

社区获得性肺炎(CAP)是儿童最常见的疾病,在我国是5岁以下小儿死亡的主要原因.常见病原包括细菌、病毒及非典型病原(支原体、衣原体、军团菌等).肺炎链球菌是引起儿童CAP的最主要细菌病原,呼吸道合胞病毒是最常见病毒病原.儿童年龄越小病毒感染的可能性越大,住院时间越长细菌感染的比率随之增高,儿童CAP病原分布随国家、地区、时代不同而有很大差异.动态了解当地呼吸道感染的主要病原和各年龄组患儿感染病原的主要种类,既可以协助临床诊断和治疗,还对当地区疾病预防控制工作中采取针对性预防措施具有重要的指导意义.     

C-反应蛋白在老年社区获得性肺炎与医院获得性肺炎中的比较研究

目的 分析血清C-反应蛋白(CRP)水平在老年不同病原菌肺部感染中的诊断作用.方法 对医院的98例社区获得性肺炎(CAP)、128例医院获得性肺炎(HAP)住院患者血中CRP、白细胞(WBC)、中性粒细胞(N)进行测定,并对痰标本进行病原菌分离鉴定.结果 CAP、HAP患者血中CRP水平分别为(79.8±16.2) mg/L和(46.4±8.4)mg/L,两组间差异有统计学意义(P＜0.01),而WBC、N则无明显差异;CAP患者病原菌检出率为43.88％,以革兰阳性球菌为主占27.55％,HAP患者病原菌检出率为63.28％,以革兰阴性杆菌为主占56.25％,两组患者的病原菌检出率、构成比差异均有统计学意义(P＜0.01).结论 CAP患者CRP水平显著高于HAP患者,两组患者感染的病原菌存在显著性差异,测定CRP水平有助于区分两组患者,指导临床合理选用抗菌药物.     

我院抗菌药物治疗儿童社区获得性肺炎疗效评价及成本-效果分析

目的：评价我院抗菌药物治疗儿童社区获得性肺炎（CAP）的疗效并进行成本-效果分析,为临床提供参考。方法：将我院2012年1月至2013年1月收治的202例中、重度CAP患儿,按抗菌药物治疗方案分为五组——I组（37例）：头孢呋辛钠＋阿奇霉素;II组（32例）：头孢噻肟钠＋阿奇霉素;Ⅲ组（48例）：头孢哌酮钠／舒巴坦钠＋阿奇霉素;1V组（44例）：头孢他啶＋阿奇霉素;V组（41例）：头孢吡肟＋阿奇霉素。评价各组临床疗效和不良反应,并进行成本-效果分析。结果：五组总有效率分别为75．68％、78．13％、85．42％、86．36％、82．93％,病原菌清除率分别为76．47％、78．57％、82．61％、85．71％、84．21％,不良反应发生率分别为2．70％、3．13％、4．17％、4．55％、4．88％,组间比较差异均无统计学意义（P均〉O．05）。应用经济学原理分析显示I组成本最小（539．35元）,V组最大（626．36元）;计算各组的C／E值,Ⅳ组最小（6．80）,V组最大（7．55）;以成本最小的I组为参照计算各组△c／△E值,Ⅳ组最小（4．49）,V组最大（12．00）。结论：五组总有效率、细菌清除率和不良反应发生率相当,但Ⅳ组（头孢他啶＋阿奇霉素）最经济,为治疗儿童CAP的首选方案。     

Comparison of hospitalization rates in patients with community-acquired pneumonia treated with 10 days of telithromycin or clarithromycin

SUMMARY

Aims: To compare the impact on hospitalization rates and the clinical efficacy of oral telithromycin and clarithromycin treatment in patients with community-acquired pneumonia (CAP).

Patients and methods: Outpatients aged >18 years (n?=?448) with CAP were enrolled in a randomized, double-blind, multinational study and received telithromycin 800?mg once daily (n?=?224) or clarithromycin 500?mg twice daily (n?=?224) for 10 days. The primary outcome measure was clinical efficacy at post-therapy/test of cure (Days 17–24) in the per-protocol population. Frequency of CAP-related hospitalizations, physician visits/tests/procedures, and additional respiratory tract infection-related antibacterial use were compared by treatment group (intent to treat population) up to the late post-therapy visit (Days 31-36). Study investigators who were blinded to the treatment arm assessed whether hospital admissions were CAP related or not. Hospitalization costs (US$) associated with telithromycin and clarithromycin treatment were compared.

Results: Per-protocol clinical cure rates for telithromycin and clarithromycin were statistically equivalent (88.3% [143/162] vs 88.5% [138/156] - difference: ?0.2%; 95% CI: ?7.8, 7.5). There were four CAP-related hospitalizations (1.8 events/100 patients) among patients treated with telithromycin vs eight (3.6 events/100 patients) among clarithromycin patients (p?=?0.281). The total number of CAP-related hospital days for telithromycin and clarithromycin patients was 23 vs 64 days (10.3 vs 28.6 days/100 patients), respectively (p?=?0.177). CAP-related hospitalization costs per 100 telithromycin and clarithromycin patients were $20360 vs $70567, respectively (difference: ?25182; 95% CI: ?49531; 9168).

Conclusions: This study demonstrates that telithromycin is an effective therapy for outpatients with CAP. There were no significant differences in hospitalization rates between treatments; however, a tendency towards a numerically reduced number of hospitalizations/days required in hospital among telithromycin patients was observed. This could potentially translate into reduced hospitalization costs for telithromycin vs clarithromycin in the treatment of CAP.     

A cost-effectiveness analysis of antimicrobial treatment of community-acquired pneumonia taking into account resistance in Belgium

ABSTRACT

Objective: This article assesses the cost-effectiveness of outpatient antimicrobial treatment of community-acquired pneumonia (CAP) taking into account resistance in Belgium.

Research design and methods: Our decision analytic model focused on mild to moderate CAP, but did not consider severe CAP. Treatment pathways reflected empirical treatment initiated in the absence of data on CAP aetiology. First-line treatment consisted of moxifloxacin, co-amoxiclav, cefuroxime or clarithromycin. If first-line treatment was unsuccessful, patients were either hospitalised or second-line treatment with a different antimicrobial was initiated. Clinical failure rates were obtained from the published literature or expert opinion. Costs were calculated using published sources from the third-party payer perspective.

Main outcome measures: Effectiveness measures included first-line clinical failure avoided, second-line treatment avoided, hospitalisation avoided and death avoided. Healthcare costs were included, but costs of productivity loss were not considered.

Results: Costs of treating a CAP episode amounted to 144€ with moxifloxacin/co-amoxiclav; 222€ with co-amoxiclav/clarithromycin; 211€ with cefuroxime/moxifloxacin; and 193€ with clarithromycin/moxifloxacin. The rate of first-line failure was 5%, 16%, 19% and 18% for these four treatment strategies, respectively. The rate of second-line treatment amounted to 4%, 13%, 16% and 15%, respectively. The hospitalisation rate was 1%, 4%, 4% and 4%, respectively. The death rate was 0.01%, 0.04%, 0.03% and 0.03%, respectively. Sensitivity analyses supported the dominance of moxifloxacin/co-amoxiclav in nearly all scenarios.

Conclusions: First-line treatment of CAP patients with moxifloxacin followed by co-amoxiclav or hospitalisation if required was more effective and less costly as compared with first-line treatment with co-amoxiclav, cefuroxime or clarithromycin.