Influenza and Bacterial Coinfection in Adults With Community-Acquired Pneumonia Admitted to Conventional Wards: Risk Factors, Clinical Features, and Outcomes
Influenza and Bacterial Coinfection in Adults With Community-Acquired Pneumonia Admitted to Conventional Wards: Risk Factors, Clinical Features, and Outcomes
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DOI：
10.1093/ofid/ofaa066
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发表时间：
2020-03-01
影响因子：
4.2
通讯作者：
Carratala, Jordi
中科院分区：
文献类型：
--
作者：
Abelenda-Alonso, Gabriela;Rombauts, Alexander;Carratala, Jordi
背景资料。在非重症监护病房(ICU)住院的成人社区获得性肺炎(CAP)中，病毒和细菌混合感染(VBC)的相关性很差。我们的目标是在这种情况下确定VBCCAP的危险因素、特征和结果。这是一组住进传统病房的CAP成人的前瞻性队列。将患者分为VBC-CAP组、病毒性CAP组(V-CAP)和细菌性CAP组(B-CAP)。确定了VBC-CAP的独立危险因素和预后因素。共记录1123例：VBC-CAP 57例(5.1%)，V-CAP 98例(8.7%)，B-CAP 968例(86.1%)。VBCCAP患者比B-CAP患者年轻(54岁比71岁；P<；.001)。VBC-CAP患者慢性呼吸道疾病的发生率高于V-CAP患者(26.3%vs14.3%；P=.001)。在153例流感患者中，VBC-CAP组较少接受经验性奥司他韦治疗(56.1%vs73.5%；P<；.001)。VBC-CAP患者有更多的呼吸窘迫(21.1%的VBC-CAP、19.4%的V-CAP和9.8%的B-CAP；P&t；001)和更频繁地需要ICU入院(31.6%的VBC-CAP、31.6%的V-CAP和12.8%的B-CAP；P&t；001)。30d病死率VBC-CAP组为3.5%，V-CAP组为3.1%，B-CAP组为6.3%(P=.232)。此外，VBC-CAP与严重程度标准(优势比[OR]，5.219；P<；.001)和流感病例缺乏经验性奥司他韦治疗(OR，0.401；P<；.043)相关。病毒和细菌混合感染-CAP涉及患有共病和流感疫苗接种率较低的年轻患者。VBC-CAP患者出现更多的呼吸道并发症，更多地需要ICU入院。然而，30天的死亡率很低，这与严重程度标准或延迟开始奥司他韦治疗有关。
Background. Relevance of viral and bacterial coinfection (VBC) in non-intensive care unit (ICU) hospitalized adults with community-acquired pneumonia (CAP) is poorly characterized. We aim to determine risk factors, features, and outcomes of VBCCAP in this setting.Methods. This is a prospective cohort of adults admitted to conventional wards with CAP. Patients were divided into VBC-CAP, viral CAP (V-CAP), and bacterial CAP (B-CAP) groups. Independent risk and prognostic factors for VBC-CAP were identified.Results. We documented 1123 episodes: 57 (5.1%) VBC-CAP, 98 (8.7%) V-CAP, and 968 (86.1%) B-CAP. Patients with VBCCAP were younger than those with B-CAP (54 vs 71 years; P < .001). Chronic respiratory disease was more frequent in patients with VBC-CAP than in those with V-CAP (26.3% vs 14.3%%; P = .001). Among those with influenza (n = 153), the VBC-CAP group received empirical oseltamivir less often (56.1% vs 73.5%; P < .001). Patients with VBC-CAP also had more respiratory distress (21.1% VBC-CAP; 19.4% V-CAP, and 9.8% B-CAP; P < .001) and required ICU admission more often (31.6% VBC-CAP, 31.6% V-CAP, and 12.8% B-CAP; P < .001). Me 30-day case-fatality rate was 3.5% in the VBC-CAP group, 3.1% in the V-CAP group, and 6.3% in the B-CAP group (P = .232). Furthermore, VBC-CAP was associated with severity criteria (odds ratio [OR], 5.219; P < .001) and lack of empirical oseltamivir therapy in influenza cases (OR, 0.401; P < .043).Conclusions. Viral and bacterial coinfection-CAP involved younger patients with comorbidities and with poor influenza vaccination rate. Patients with VBC-CAP presented more respiratory complications and more often required ICU admission. Nevertheless, 30-day mortality rate was low and related either to severity criteria or to delayed initiation of oseltamivir therapy.