Community-Acquired Respiratory Coinfection in Critically III Patients With Pandemic 2009 Influenza A(H1N1) Virus
Community-Acquired Respiratory Coinfection in Critically III Patients With Pandemic 2009 Influenza A(H1N1) Virus
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DOI：
10.1378/chest.10-1396
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发表时间：
2011-03-01
期刊：
影响因子：
9.6
通讯作者：
Rodriguez, Alejandro
中科院分区：
文献类型：
--
作者：
Martin-Loeches, Ignacio;Sanchez-Corral, Ana;Rodriguez, Alejandro
背景：人们对社区获得性呼吸道合并感染对 2009 年大流行甲型 H1N1 流感病毒感染患者的影响知之甚少。方法：这是一项在 148 个西班牙 ICU 中进行的前瞻性、观察性、多中心研究。结果：645 名 ICU 患者出现严重呼吸综合征。 113 名患者（17.5%）发生混合感染。肺炎链球菌（62 名患者 [54.8%]）被确定为最常见的细菌。入ICU时合并感染的患者年龄较大（47.5 +/- 15.7 vs 43.8 +/- 14.2岁，P < .05），并表现出较高的APACHE（急性生理学和慢性健康评估）II评分（16.1 +/- 7.3 vs 13.3 +/- 7.1，P < .05）和序贯器官衰竭评估（SOFA）评分（7.0 +/- .05） 3.8 与 5.2 +/- 3.5，P < .05）。没有观察到合并症的差异。合并感染的患者更频繁地需要血管加压药（63.7% vs 39.3%，P < .05）和有创机械通气（69% vs 58.5%，P < .05）。合并感染患者的 ICU 住院时间比未合并感染的患者长 3 天（11 [四分位距，5-23] vs 8 [四分位距 4-17]，P = .01）。合并感染与 ICU 死亡率增加相关（26.2% vs 15.5%；OR，1.94；95% CI，1.21-3.09），但通过潜在混杂因素调整的 Cox 回归分析并未证实合并感染与 ICU 死亡率之间存在显着关联。结论：在 2009 年大流行期间，细菌合并感染在将患者送入 ICU 方面所起的作用尚不清楚，S 肺炎链球菌是最常见的病原体。这项工作提供了明确的证据，表明细菌合并感染是导致感染该病毒的危重患者卫生资源消耗增加的一个因素，并且是在绝大多数情况下导致危重疾病的病毒。胸部 2011； 139(3):555-562
Background: Little is known about the impact of community-acquired respiratory coinfection in patients with pandemic 2009 influenza A(H1N1) virus infection.Method: This was a prospective, observational, multicenter study conducted in 148 Spanish ICUs.Results: Severe respiratory syndrome was present in 645 ICU patients. Coinfection occurred in 113 (17.5%) of patients. Streptococcus pneumoniae (in 62 patients [54.8%]) was identified as the most prevalent bacteria. Patients with coinfection at ICU admission were older (47.5 +/- 15.7 vs 43.8 +/- 14.2 years, P < .05) and presented a higher APACHE (Acute Physiology and Chronic Health Evaluation) II score (16.1 +/- 7.3 vs 13.3 +/- 7.1, P < .05) and Sequential Organ Failure Assessment (SOFA) score (7.0 +/- 3.8 vs 5.2 +/- 3.5, P < .05). No differences in comorbidities were observed. Patients who had coinfection required vasopressors (63.7% vs 39.3%, P < .05) and invasive mechanical ventilation (69% vs 58.5%, P < .05) more frequently. ICU length of stay was 3 days longer in patients who had coinfection than in patients who did not (11 [interquartile range, 5-23] vs 8 [interquartile range 4-17], P = .01). Coinfection was associated with increased ICU mortality (26.2% vs 15.5%; OR, 1.94; 95% CI, 1.21-3.09), but Cox regression analysis adjusted by potential confounders did not confirm a significant association between coinfection and ICU mortality.Conclusions: During the 2009 pandemics, the role played by bacterial coinfection in bringing patients to the ICU was not clear, S pneumoniae being the most common pathogen. This work provides clear evidence that bacterial coinfection is a contributor to increased consumption of health resources by critical patients infected with the virus and is the virus that causes critical illness in the vast majority of eases. CHEST 2011; 139(3):555-562