Causes and incidence of community-acquired serious infections among young children in south Asia (ANISA): an observational cohort study.
Causes and incidence of community-acquired serious infections among young children in south Asia (ANISA): an observational cohort study.
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DOI：
10.1016/s0140-6736(18)31127-9
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发表时间：
2018-07-14
期刊：
影响因子：
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通讯作者：
Baqui AH
中科院分区：
文献类型：
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作者：
Saha SK;Schrag SJ;El Arifeen S;Mullany LC;Shahidul Islam M;Shang N;Qazi SA;Zaidi AKM;Bhutta ZA;Bose A;Panigrahi P;Soofi SB;Connor NE;Mitra DK;Isaac R;Winchell JM;Arvay ML;Islam M;Shafiq Y;Nisar I;Baloch B;Kabir F;Ali M;Diaz MH;Satpathy R;Nanda P;Padhi BK;Parida S;Hotwani A;Hasanuzzaman M;Ahmed S;Belal Hossain M;Ariff S;Ahmed I;Ibne Moin SM;Mahmud A;Waller JL;Rafiqullah I;Quaiyum MA;Begum N;Balaji V;Halen J;Nawshad Uddin Ahmed ASM;Weber MW;Hamer DH;Hibberd PL;Sadeq-Ur Rahman Q;Mogan VR;Hossain T;McGee L;Anandan S;Liu A;Panigrahi K;Abraham AM;Baqui AH
每年有超过 500 名新生儿死于可能的严重细菌感染 (pSBI)，但其原因很大程度上尚不清楚。我们调查了南亚新生儿中由特定微生物引起的社区获得性感染的发生率。 2011 年至 2014 年，我们通过在孟加拉国、印度和巴基斯坦的五个地点进行基于人群的妊娠监测来识别婴儿。从 0 岁到 59 天，社区卫生工作者到家中探望婴儿多达 10 次。符合世界卫生组织 pSBI 定义的疾病和随机选择的健康婴儿被转介给研究医生。主要目标是通过血液和呼吸道样本的血培养和定制 TaqMan 阵列卡分子测定（Thermo Fisher，Bartlesville，OK，USA）估计特定感染原因的比例。在 63 114 名婴儿中发现了 6022 次 pSBI 发作（每 1000 名活产婴儿中有 95·4 次）。 28% 的事件归因于原因（16% 为细菌性，12% 为病毒性）。细菌感染的平均发生率为每 1000 名活产 13·2（95% 可信区间 [CrI] 11·2–15·6），病毒感染的平均发生率为每 1000 名活产 10·1 (9·4–11·6)。主要病原体是呼吸道合胞病毒（5·4、95% CrI 每 1000 个活产儿 4·8–6·3 次），其次是解脲支原体（每 1000 个活产儿 2·4、1·6–3·2 次）。在死亡婴儿中，46% 的原因归因于 pSBI 事件，其中 92% 是细菌性死亡。 102 个血培养分离株中的 85 个（83%）对青霉素、氨苄西林、庆大霉素或这些药物的组合敏感。大部分患者无法归因原因，这表明很大一部分 pSBI 发作可能不是由感染引起的。然而，死亡婴儿中细菌原因占主导地位，这表明适当的预防措施和管理可能会极大地影响新生儿死亡率。细菌分离株对一线抗生素的敏感性强调需要谨慎和有限地使用新一代抗生素。此外，我们发现的非典型细菌占主导地位和呼吸道合胞病毒的高发病率表明需要改变治疗和预防的管理策略。鉴于疾病负担，预防呼吸道合胞病毒将对整个卫生系统和可持续发展目标的实现产生显着影响。比尔及梅琳达·盖茨基金会
More than 500 000 neonatal deaths per year result from possible serious bacterial infections (pSBIs), but the causes are largely unknown. We investigated the incidence of community-acquired infections caused by specific organisms among neonates in south Asia. From 2011 to 2014, we identified babies through population-based pregnancy surveillance at five sites in Bangladesh, India, and Pakistan. Babies were visited at home by community health workers up to ten times from age 0 to 59 days. Illness meeting the WHO definition of pSBI and randomly selected healthy babies were referred to study physicians. The primary objective was to estimate proportions of specific infectious causes by blood culture and Custom TaqMan Array Cards molecular assay (Thermo Fisher, Bartlesville, OK, USA) of blood and respiratory samples. 6022 pSBI episodes were identified among 63 114 babies (95·4 per 1000 livebirths). Causes were attributed in 28% of episodes (16% bacterial and 12% viral). Mean incidence of bacterial infections was 13·2 (95% credible interval [CrI] 11·2–15·6) per 1000 livebirths and of viral infections was 10·1 (9·4–11·6) per 1000 livebirths. The leading pathogen was respiratory syncytial virus (5·4, 95% CrI 4·8–6·3 episodes per 1000 livebirths), followed by Ureaplasma spp (2·4, 1·6–3·2 episodes per 1000 livebirths). Among babies who died, causes were attributed to 46% of pSBI episodes, among which 92% were bacterial. 85 (83%) of 102 blood culture isolates were susceptible to penicillin, ampicillin, gentamicin, or a combination of these drugs. Non-attribution of a cause in a high proportion of patients suggests that a substantial proportion of pSBI episodes might not have been due to infection. The predominance of bacterial causes among babies who died, however, indicates that appropriate prevention measures and management could substantially affect neonatal mortality. Susceptibility of bacterial isolates to first-line antibiotics emphasises the need for prudent and limited use of newer-generation antibiotics. Furthermore, the predominance of atypical bacteria we found and high incidence of respiratory syncytial virus indicated that changes in management strategies for treatment and prevention are needed. Given the burden of disease, prevention of respiratory syncytial virus would have a notable effect on the overall health system and achievement of Sustainable Development Goal. Bill & Melinda Gates Foundation