Outcomes of respiratory viral-bacterial co-infection in adult hospitalized patients.
Outcomes of respiratory viral-bacterial co-infection in adult hospitalized patients.
复制标题
成人住院患者呼吸道病毒-细菌混合感染的结果
DOI：
10.1016/j.eclinm.2021.100955
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发表时间：
2021-07
影响因子：
15.1
通讯作者：
Zhang L
中科院分区：
文献类型：
--
作者：
Liu Y;Ling L;Wong SH;Wang MH;Fitzgerald JR;Zou X;Fang S;Liu X;Wang X;Hu W;Chan H;Wang Y;Huang D;Li Q;Wong WT;Choi G;Zou H;Hui DS;Yu J;Tse G;Gin T;Wu WK;Chan MT;Zhang L
呼吸道病毒感染是一个重大的全球健康问题。与细菌混合感染可能会导致严重的疾病和增加患者的死亡率。然而，迄今为止，病毒和细菌混合感染的模式及其临床结果还没有得到很好的描述。本研究旨在探讨呼吸道病毒-细菌混合感染患者的临床特点和转归。我们使用一个大型全港医疗数据库，纳入2013至2017年间香港四间三级医院因呼吸道病毒[甲型及乙型流感、呼吸道合胞病毒(RSV)、副流感]及/或细菌而引致呼吸道感染的19,361名患者。所有微生物检查均在入院后48小时内进行。四个病因组包括：(1)单纯病毒感染；(2)单独细菌感染；(3)实验室确诊的病毒与细菌混合感染；(4)临床疑似病毒与细菌混合感染，呼吸道病毒检测呈阳性，细菌检测为阴性，但接受过至少4天的抗生素治疗。实验室确认的病毒-细菌混合感染患者的临床特征和结果被记录下来，并与其他三组作为对照。主要结果是30天的死亡率。次要结果是重症监护病房(ICU)入院和住院时间。通过二元Logistic回归估计的倾向性得分匹配被用来调整可能影响结果和协变量之间关联的潜在偏倚。在15,906名呼吸道病毒感染患者中，有8451名(53.1%)临床疑似患者和1087名(6.8%)实验室确认的病毒与细菌混合感染。其中流感嗜血杆菌(226/1087，20.8%)、铜绿假单胞菌(180/1087，16.6%)和肺炎链球菌(123/1087，11.3%)是实验室确诊合并感染组最常见的3种致病菌。呼吸道病毒与非肺炎链球菌或耐甲氧西林金黄色葡萄球菌混合感染的死亡率最高[分别为9/30(30%)和13/48(27.1%)]。与其他感染组相比，经实验室确认合并感染的患者有更高的ICU住院率(P=0.001)和30天的死亡率(P=0.028)，并且在使用倾向分数匹配调整潜在混杂因素后，这些结果持续存在。此外，与仅有细菌感染的患者相比，经实验室确认的合并感染的患者的死亡率显著更高。在我们的队列中，细菌合并感染在住院的病毒性呼吸道感染患者中很常见，并与较高的ICU住院率和死亡率相关。因此，可能需要积极监测细菌合并感染和早期抗生素治疗，以改善呼吸道病毒感染患者的预后。
Viral infections of the respiratory tract represent a major global health concern. Co-infection with bacteria may contribute to severe disease and increased mortality in patients. Nevertheless, viral-bacterial co-infection patterns and their clinical outcomes have not been well characterized to date. This study aimed to evaluate the clinical features and outcomes of patients with viral-bacterial respiratory tract co-infections. We included 19,361 patients with respiratory infection due to respiratory viruses [influenza A and B, respiratory syncytial virus (RSV), parainfluenza] and/or bacteria in four tertiary hospitals in Hong Kong from 2013 to 2017 using a large territory-wide healthcare database. All microbiological tests were conducted within 48 h of hospital admission. Four etiological groups were included: (1) viral infection alone; (2) bacterial infection alone; (3) laboratory-confirmed viral-bacterial co-infection and (4) clinically suspected viral-bacterial co-infection who were tested positive for respiratory virus and negative for bacteria but had received at least four days of antibiotics. Clinical features and outcomes were recorded for laboratory-confirmed viral-bacterial co-infection patients compared to other three groups as control. The primary outcome was 30-day mortality. Secondary outcomes were intensive care unit (ICU) admission and length of hospital stay. Propensity score matching estimated by binary logistic regression was used to adjust for the potential bias that may affect the association between outcomes and covariates. Among 15,906 patients with respiratory viral infection, there were 8451 (53.1%) clinically suspected and 1,087 (6.8%) laboratory-confirmed viral-bacterial co-infection. Among all the bacterial species, Haemophilus influenzae (226/1,087, 20.8%), Pseudomonas aeruginosa (180/1087, 16.6%) and Streptococcus pneumoniae (123/1087, 11.3%) were the three most common bacterial pathogens in the laboratory-confirmed co-infection group. Respiratory viruses co-infected with non-pneumococcal streptococci or methicillin-resistant Staphylococcus aureus was associated with the highest death rate [9/30 (30%) and 13/48 (27.1%), respectively] in this cohort. Compared with other infection groups, patients with laboratory-confirmed co-infection had higher ICU admission rate (p < 0.001) and mortality rate at 30 days (p = 0.028), and these results persisted after adjustment for potential confounders using propensity score matching. Furthermore, patients with laboratory-confirmed co-infection had significantly higher mortality compared to patients with bacterial infection alone. In our cohort, bacterial co-infection is common in hospitalized patients with viral respiratory tract infection and is associated with higher ICU admission rate and mortality. Therefore, active surveillance for bacterial co-infection and early antibiotic treatment may be required to improve outcomes in patients with respiratory viral infection.
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影响因子：
4.4
作者：
Haq, Kamran;McElhaney, Janet E.
通讯作者：
McElhaney, Janet E.
影响因子：
5.9
作者：
GARIBALDI, RA
通讯作者：
GARIBALDI, RA
影响因子：
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作者：
Goncheva, Mariya, I;Conceicao, Carina;Fitzgerald, J. Ross
通讯作者：
Fitzgerald, J. Ross
影响因子：
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作者：
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通讯作者：
Paranhos-Baccalà G
影响因子：
3
作者：
Coughtrie, Abigail L.;Morris, Denise E.;Clarke, Stuart C.
通讯作者：
Clarke, Stuart C.