Influenza-Associated Pneumonia Among Hospitalized Patients With 2009 Pandemic Influenza A (H1N1) Virus-United States, 2009
Influenza-Associated Pneumonia Among Hospitalized Patients With 2009 Pandemic Influenza A (H1N1) Virus-United States, 2009
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DOI：
10.1093/cid/cis197
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发表时间：
2012-05-01
影响因子：
11.8
通讯作者：
Finelli, Lyn
中科院分区：
文献类型：
--
作者：
Jain, Seema;Benoit, Stephen R.;Finelli, Lyn
背景肺炎是2009年美国甲型H1N1流感住院患者的常见并发症。通过2009年春季和秋季进行的2个国家病例系列，对病历进行了审查。肺炎病例定义为实验室确诊pH 1 N1病毒的住院患者，根据3名医生的一致意见，胸部X线片报告符合肺炎。在451例进行胸片检查的患者中，195例（43%）患有肺炎（春季，237例中的106例[45%];秋季，214例中的89例[42%]）。与256例非肺炎患者相比，这195例肺炎患者更容易进入重症监护室（52% vs 16%），发生急性呼吸窘迫综合征（ARDS; 26% vs 2%），脓毒症（18% vs 3%）和死亡（17% vs 2%; P <0.0001）。118例（61%）肺炎患者有>= 1种基础疾病。13例肺炎患者和2例非肺炎患者报告了细菌感染。与非肺炎患者相比，肺炎患者接受流感抗病毒药物治疗的可能性相同（78% vs 79%），但在发病后2天内接受抗病毒药物治疗的可能性较低（28% vs 50%; P < .0001）。pH 1 N1和肺炎住院患者有发生严重结局的风险，包括ARDS、败血症和死亡;抗病毒治疗通常被延迟。在没有准确肺炎诊断的情况下，因胸部X线检查怀疑流感和肺浸润而住院的患者应接受早期和积极的抗生素和流感抗病毒剂治疗。
Background. Pneumonia was a common complication among hospitalized patients with 2009 pandemic influenza A H1N1 [pH1N1] in the United States in 2009.Methods. Through 2 national case series conducted during spring and fall of 2009, medical records were reviewed. A pneumonia case was defined as a hospitalized person with laboratory-confirmed pH1N1 virus and a chest radiographic report consistent with pneumonia based on agreement among 3 physicians.Results. Of 451 patients with chest radiographs performed, 195 (43%) had pneumonia (spring, 106 of 237 [45%]; fall, 89 of 214 [42%]). Compared with 256 patients without pneumonia, these 195 patients with pneumonia were more likely to be admitted to the intensive care unit (52% vs 16%), have acute respiratory distress syndrome (ARDS; 26% vs 2%), have sepsis (18% vs 3%), and die (17% vs 2%; P < .0001). One hundred eighteen (61%) of the patients with pneumonia had >= 1 underlying condition. Bacterial infections were reported in 13 patients with pneumonia and 2 patients without pneumonia. Patients with pneumonia, when compared with patients without pneumonia, were equally likely to receive influenza antiviral agents (78% vs 79%) but less likely to receive antiviral agents within < 2 days of illness onset (28% vs 50%; P < .0001).Conclusions. Hospitalized patients with pH1N1 and pneumonia were at risk for severe outcomes including ARDS, sepsis, and death; antiviral treatment was often delayed. In the absence of accurate pneumonia diagnostics, patients hospitalized with suspected influenza and lung infiltrates on chest radiography should receive early and aggressive treatment with antibiotics and influenza antiviral agents.