BACTERIAL ETIOLOGY OF ACUTE LOWER RESPIRATORY-INFECTIONS IN PRESCHOOL NIGERIAN CHILDREN AND COMPARATIVE PREDICTIVE FEATURES OF BACTEREMIC AND NON-BACTEREMIC ILLNESSES
BACTERIAL ETIOLOGY OF ACUTE LOWER RESPIRATORY-INFECTIONS IN PRESCHOOL NIGERIAN CHILDREN AND COMPARATIVE PREDICTIVE FEATURES OF BACTEREMIC AND NON-BACTEREMIC ILLNESSES
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DOI：
10.1093/tropej/39.2.97
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发表时间：
1993-04-01
影响因子：
2
通讯作者：
ADEYEMIDORO, FAB
中科院分区：
文献类型：
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作者：
JOHNSON, AWBR;OSINUSI, K;ADEYEMIDORO, FAB
在对尼日利亚学龄前住院儿童引起急性下呼吸道感染（ALRI）的微生物进行的9个月监测中，从66例血培养中的22例（33%）中分离出24株细菌，其中包括胸腔积液受试者10例培养物中的7例（70%）。在24个阳性分离株中，金黄色葡萄球菌占14个（58%），肺炎克雷伯菌占4个（17%），肺炎链球菌和白色葡萄球菌各占2个（8%），流感嗜血杆菌仅占1个病例。7例受试者具有混合病因，包括1例麻疹菌血症病例和6例伴随病毒鉴定。16个病例，其中10人（63%）营养不良，感染两种或两种以上病原体，包括10人感染多种病毒。咽喉部的细菌分离株对ALRI的病因学没有显著的预测作用。明显的营养不良、脓胸和贫血在菌血症病例中明显更常见（P < 0.03、0.01和0.05），而腹泻和捻发音与非菌血症病例相关。（P = 0.05和< 0.05）。在混合病因组中，溢液、喘鸣/干鸣与混合病因组的相关性相似（分别为P < 0.05和0.05）。菌血症患者的病死率为9%，是非菌血症患者的2.1倍，后者的平均住院时间较短。在发展中国家，需要定期监测ALRI病原体，作为制定合理的抗菌政策的先决条件，强调。我们的研究结果强调了营养不良作为严重菌血症ALRI的危险因素的预测重要性，通常与多种病原体相关。血培养在确定ALRI的细菌因子的相对有用性进行了讨论。
In a 9-month surveillance of the microbial agents causing acute lower respiratory infections (ALRI) in hospitalized preschool Nigerian children, 24 bacterial isolates were made from 22 (33 per cent) out of 66 blood cultures, including seven (70 per cent) of the 10 cultures from subjects with pleural effusion. Of the 24 positive isolates, Staphylococcus aureus accounted for 14 (58 per cent), Klebsiella pneumoniae for four (17 per cent), Streptococcus pneumoniae and Staphylococcus albus for two (8 per cent) each, and Haemophilus influenzae for only one case. Seven subjects had a mixed aetiology, comprising one bacteraemic case with measles and six with concomitant viral identifications. Sixteen cases, 10 (63 per cent) of whom were malnourished, had two or more pathogens, including 10 with multiple viruses. Bacterial isolates from the throat, were not significantly predictive of the ALRI aetiology. Overt malnutrition, empyema, and anaemia, were significantly commoner in bacteraemic cases (P < 0.03, 0.01, and 0.05), while rhinorrhoea and crepitations were each associated with the non-bacteraemic ones. (P = 0.05 and < 0.05). A similar association was shown between rhinorrhoea, wheezing/rhonchi and the mixed aetiological group (P < 0.05 and 0.05, respectively). The case-fatality in bacteraemic subjects, was 9 per cent and was 2.1 times higher than that for non-bacteraemic cases, in whom a shorter mean duration of admission was recorded. In developing countries, the need for periodic local surveillance of ALRI pathogens, as a prerequisite for evolving rational antimicrobial policies, is emphasized. Our findings underscore the predictive importance of malnutrition as a risk-factor of severe bacteraemic ALRI, frequently associated with multiple pathogens. The relative usefulness of blood culture in identifying bacterial agents of ALRI is discussed.