Increased incidence of co-infection in critically ill patients with influenza
Increased incidence of co-infection in critically ill patients with influenza
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DOI：
10.1007/s00134-016-4578-y
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发表时间：
2017-01-01
影响因子：
38.9
通讯作者：
Rodriguez, Alejandro
中科院分区：
文献类型：
--
作者：
Martin-Loeches, Ignacio;Schultz, Marcus J.;Rodriguez, Alejandro
合并感染在重症流感患者中常见，但确切的比率尚不清楚。我们确定了西班牙148个重症监护病房（ICU）7年期间流感重症患者合并感染的发生率、危险因素和与合并感染相关的结局，这是一项前瞻性、观察性、多中心研究。使用聚合酶链反应诊断流感。必须使用标准细菌学检测确认合并感染。本分析的主要终点是社区获得性合并感染的存在，次要终点包括ICU、28天和住院死亡率。在2901例确诊为流感的ICU患者中，482例（16.6%）合并感染。合并感染病例比例从2009年的11.4%（110/968）上升至2015年的23.4%（80/342）（P < 0.001）。与未合并感染的患者相比，合并感染的患者年龄更大[校正比值比（aOR）1.1，95%置信区间1.1-1.2; P < 0.001]，并且由于现有HIV感染而更频繁地出现免疫抑制（aOR 2.6 [1.5-4.5]; P < 0.001）或既往用药（aOR 1.4 [1.1-1.9]; P = 0.03）。合并感染是ICU死亡率（aOR 1.4 [1.1-1.8]; P < 0.02）、28 d死亡率（aOR 1.3 [1.1-1.7]; P = 0.04）和住院死亡率（aOR 1.9 [1.5-2.5]; P < 0.001）的独立危险因素。在这个西班牙队列中，年龄和免疫抑制是合并感染的危险因素，合并感染是ICU、28天和住院死亡率的独立危险因素。
Co-infection is frequently seen in critically ill patients with influenza, although the exact rate is unknown. We determined the rate of co-infection, the risk factors and the outcomes associated with co-infection in critically ill patients with influenza over a 7-year period in 148 Spanish intensive care units (ICUs).This was a prospective, observational, multicentre study. Influenza was diagnosed using the polymerase chain reaction. Co-infection had to be confirmed using standard bacteriological tests. The primary endpoint of this analysis was the presence of community-acquired co-infection, with secondary endpoints including ICU, 28-day and hospital mortality.Of 2901 ICU patients diagnosed with influenza, 482 (16.6 %) had a co-infection. The proportion of cases of co-infection increased from 11.4 % (110/968) in 2009 to 23.4 % (80/342) in 2015 (P < 0.001). Compared with patients without co-infection, patients with co-infection were older [adjusted odds ratio (aOR) 1.1, 95 % confidence interval 1.1-1.2; P < 0.001] and were more frequently immunosuppressed due to existing HIV infection (aOR 2.6 [1.5-4.5]; P < 0.001) or preceding medication (aOR 1.4 [1.1-1.9]; P = 0.03). Co-infection was an independent risk factor for ICU mortality (aOR 1.4 [1.1-1.8]; P < 0.02), 28-day mortality (aOR 1.3 [1.1-1.7]; P = 0.04) and hospital mortality (aOR 1.9 [1.5-2.5]; P < 0.001).Co-infection in critically ill patients with influenza has increased in recent years. In this Spanish cohort, age and immunosuppression were risk factors for co-infection, and co-infection was an independent risk factor for ICU, 28-day and hospital mortality.