High Rates of Premature and Potentially Preventable Death among Patients Surviving Melioidosis in Tropical Australia
High Rates of Premature and Potentially Preventable Death among Patients Surviving Melioidosis in Tropical Australia
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DOI：
10.4269/ajtmh.19-0375
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发表时间：
2019-01-01
影响因子：
3.3
通讯作者：
Smith, Simon
中科院分区：
文献类型：
--
作者：
Hanson, Josh;Smith, Simon
尽管澳大利亚类鼻疽患者的院内死亡率持续下降，但幸存者随后的临床病程却很少被描述。 1998年1月1日至2019年1月31日期间，澳大利亚热带地区凯恩斯有228名类鼻疽患者在住院后幸存下来；然而，52 人（23%）随后死亡。死亡发生在出院后平均 3.8 年，患者死亡的平均年龄为 59 岁。只有 1/27 (4%) 没有类鼻疽诱发条件的患者在随访期间死亡，而有这些合并症的患者为 51/ 201 (25%)（P = 0.01）。患有慢性肺病（OR [95% CI]：4.05（1.84-8.93，P = 0.001）和慢性肾病（OR [95% CI]：2.87 [1.33-6.20]，P = 0.007）的患者在随访期间死亡的可能性更大，最常见的原因是感染和大血管疾病。澳大利亚人因类鼻疽住院而幸存的比例很高不久之后就会死去 通常因可预防的情况而过早且频繁地放电。需要采取更全面的方法来照顾他们。
Although the in-hospital mortality of Australian patients with melioidosis continues to decline, the ensuing clinical course of survivors is poorly described. Between January 1, 1998, and January 31, 2019, 228 patients in Cairns, tropical Australia, survived their hospitalization with melioidosis; however, 52 (23%) subsequently died. Death occurred at a median of 3.8 years after discharge, with patients dying at a mean age of 59 years. Only 1/27 (4%) without predisposing conditions for melioidosis died during follow-up, versus 51/ 201 (25%) with these comorbidities (P = 0.01). Death during follow-up was more likely in patients with chronic lung disease (OR [95% CI]: 4.05 (1.84-8.93, P = 0.001) and chronic kidney disease (OR [95% CI]: 2.87 [1.33-6.20], P = 0.007), and was most commonly due to infection and macrovascular disease. A significant proportion of Australians surviving hospitalization with melioidosis will die soon after discharge, usually prematurely and frequently from preventable conditions. A more holistic approach is required to their care.