Effect of age, polymicrobial disease,, and maternal HIV status on treatment response and cause of severe pneumonia in South African children: a prospective descriptive study
Effect of age, polymicrobial disease,, and maternal HIV status on treatment response and cause of severe pneumonia in South African children: a prospective descriptive study
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年龄、多微生物疾病和母体艾滋病毒感染状况对南非儿童重症肺炎治疗反应和病因的影响：一项前瞻性描述性研究
DOI：
10.1016/s0140-6736(07)60670-9
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发表时间：
2007-04-01
期刊：
影响因子：
168.9
通讯作者：
Goldblatt, David
中科院分区：
文献类型：
--
作者：
McNally, Lisa M.;Jeena, Prakash M.;Goldblatt, David
背景 HIV 相关肺炎是南部非洲儿科住院的主要原因。我们的目的是测量南非德班因严重肺炎入院的儿童治疗失败的预测因素和无反应性肺炎的原因。方法我们调查了 358 名 1-59 个月的儿童，这些儿童患有世界卫生组织定义的严重或非常严重的肺炎。无论艾滋病毒状况如何，儿童都被招募并开始接受苄青霉素和庆大霉素的标准抗菌治疗方案。所有婴儿还接受高剂量甲氧苄啶-磺胺甲恶唑治疗。主要结果指标是 48 小时时治疗失败。结果显示，242 名儿童 (68%) 感染了 HIV，41 名儿童 (12%) 暴露于 HIV，未感染，75 名儿童 (21%) 未感染 HIV。 1 岁以下的年龄（调整后的比值比 6.38，95% CI 2.72-14.91，p < 0.0001）、非常严重的疾病（2.47、1.17-5.24，p=0.0181）、HIV 状态（HIV 感染者 10.3、3.26-32.51；HIV 暴露、未感染）预测 48 小时内未能做出反应6.02，1.55-23.38；p=0.0003），以及多种微生物疾病（一种微生物 2.06，1.05-4.05；两种微生物 10.75，4.38-26.36；p < 0.0001）进行逻辑回归分析。所有患有三种微生物的儿童均未能接受治疗。 72/110 治疗失败至少分离出两种微生物。九名暴露于 HIV 的未感染婴儿中，有 3 名感染了 HIV，但研究治疗失败的未感染 HIV 的婴儿没有患耶氏肺孢子虫肺炎。 解释 对于 1 岁以下的儿童，WHO 指南不够充分，需要修订，因为 HIV 感染者和暴露于 HIV 的未感染婴儿比未感染 HIV 的婴儿治疗失败的情况更多。多种微生物疾病是治疗失败的重要原因，我们需要确定快速低成本的诊断方法来协助临床医生。
Background HIV-related pneumonia is the main cause of paediatric hospital admissions in southern Africa. We aimed to measure predictors of treatment failure and the cause of non-responsive pneumonia in children admitted to hospital with severe pneumonia in Durban, South Africa.Methods We investigated 358 children aged 1-59 months who presented with WHO-defined severe or very severe pneumonia. Children were recruited irrespective of HIV status and started on a standard antimicrobial regimen of benzylpenicillin and gentamicin. All infants also received high-dose trimethoprim-sulfamethoxazole. The primary outcome measure was treatment failure at 48 h.Findings 242 (68%) children were HIV infected, 41 (12%) HIV exposed, unindected, and 75 (21%) HIV uninfected. Failure to respond by 48 h was predicted by age under 1 year (adjusted odds ratio 6.38, 95% CI 2.72-14.91, p < 0.0001), very severe disease (2.47, 1.17-5.24, p=0.0181), HIV status (HIV infected 10.3, 3.26-32.51; HIV exposed, uninfected 6.02, 1.55-23.38; p=0.0003), and polymicrobial disease (one organism 2.06, 1.05-4.05; two organisms 10.75, 4.38-26.36; p < 0.0001) on logistic regression analysis. All children with three organisms failed treatment. 72/110 treatment failures had at least two organisms isolated. Three of nine HIV-exposed, uninfected infants, 29/74 HIV-infected, but no HIV-uninfected infants who failed study therapy had Pneumocystis jirovecii pneumonia.Interpretation For children younger than 1 year, the WHO guidelines are inadequate and need to be revised since both HIV-infected and HIV-exposed, uninfected infants had more treatment failures than did HIV-uninfected infants. Polymicrobial disease is an important reason for treatment failure, and we need to identify rapid low-cost diagnostic methods to assist clinicians.