肺炎链球菌全球抗菌药物非敏感性模式：按年龄、地区和感染类型分层的系统文献综述（2014-2023年）

文献信息

中文摘要

肺炎链球菌的抗菌药物非敏感性是一项重要的全球健康挑战。虽然肺炎球菌疫苗接种已显著降低肺炎球菌疾病负担，包括由抗生素耐药菌株引起的疾病，但非敏感性肺炎链球菌分离株仍是导致发病和死亡的重要因素，使治疗复杂化。治疗肺炎球菌疾病时，经验性抗生素选择应考虑当地流行病学及分离株的非敏感性特征。为全面描述不同年龄组、地理区域和感染类型中肺炎链球菌分离株对常用抗生素非敏感性的分布，我们按照PRISMA指南进行了系统文献综述。我们检索了PubMed、Medline和Embase，以获取2014年至2023年间发表的研究，这些研究报告了肺炎球菌疾病患者中检出的非敏感性肺炎链球菌分离株比例。数据进行了总体分析，并按年龄组（儿童和成人）、世界卫生组织区域和感染类型（任何侵袭性肺炎球菌疾病、脑膜炎、菌血症性肺炎、非菌血症性肺炎、菌血症/败血症和急性中耳炎）分层分析。研究质量采用纽卡斯尔-渥太华量表评估。由于观察到数据异质性，未进行荟萃分析。在识别出的1200篇出版物中，128篇（113篇全文文章和15篇会议摘要）被纳入综述，涵盖超过250,000株分离株的抗菌药物敏感性检测结果。全球范围内，非敏感性率最高的是磺胺类（52%）、大环内酯类（40%）和林可酰胺类（30%）。西太平洋地区报告的非敏感性率更高，≥91%的分离株对常用抗生素（林可酰胺类、四环素类、大环内酯类和磺胺类）非敏感；东南亚地区也观察到对四环素类和磺胺类的非敏感性升高。总体而言，儿童人群的非敏感性比例高于成人，并且随肺炎球菌感染类型的不同而显著变化。关于引起不同类型感染的肺炎链球菌分离株非敏感性特征的最新分层信息，可指导当地处方建议以使用适当抗生素，从而改善治疗结局并降低抗生素耐药性的潜在威胁。

英文摘要

Antimicrobial non-susceptibility of Streptococcus pneumoniae is an important global health challenge. While pneumococcal vaccination has significantly lowered the burden of pneumococcal disease, including that caused by antibiotic-resistant strains, non-susceptible S. pneumoniae isolates are still important contributors to morbidity and mortality, complicating treatment. Empiric antibiotic selection for treating pneumococcal disease should consider the local epidemiology and non-susceptibility profile of isolates. To comprehensively characterize the distribution of non-susceptibility to commonly used antibiotics of S. pneumoniae isolates across different age groups, geographical regions and infection types, we conducted a systematic literature review in accordance with PRISMA guidelines. We searched PubMed, Medline, and Embase to retrieve studies published between 2014 and 2023 reporting the proportion of non-susceptible S. pneumoniae isolates detected in patients with pneumococcal disease. Data were analyzed overall and stratified by age groups (pediatric and adult), World Health Organization region, and infection type (any invasive pneumococcal disease, meningitis, bacteremic pneumonia, non-bacteremic pneumonia, bacteremia/septicemia, and acute otitis media). Study quality was assessed using the Newcastle-Ottawa Scale. Due to observed data heterogeneity, meta-analysis was not performed. Of the 1200 publications identified, 128 (113 full-text articles and 15 conference abstracts) were included in the review, comprising antimicrobial susceptibility testing outcomes for >250,000 isolates. Globally, the highest non-susceptibility rates were observed for sulfonamides (52%), macrolides (40%), and lincosamides (30%). Higher rates were reported in the Western Pacific region, with ≥91% of isolates non-susceptible to commonly used antibiotics (lincosamides, tetracyclines, macrolides, and sulfonamides); elevated non-susceptibility to tetracyclines and sulfonamides was also observed in the Southeast Asian region. Non-susceptibility proportions, in general, were higher in the pediatric population than in adults, and they varied markedly by pneumococcal infection type. Up-to-date, stratified information on the non-susceptibility profile of S. pneumoniae isolates causing different types of infection can orient local prescription guidance to use appropriate antibiotics, thereby improving the treatment outcomes and reducing the potential threat of antibiotic resistance.