Epidemiology and clinical characteristics of hospitalized patients with pandemic influenza A (H1N1) 2009 infections: the effects of bacterial coinfection.
Epidemiology and clinical characteristics of hospitalized patients with pandemic influenza A (H1N1) 2009 infections: the effects of bacterial coinfection.
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DOI：
10.1186/1743-422x-8-501
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发表时间：
2011-11-03
期刊：
影响因子：
4.8
通讯作者：
Rajasekaram G
中科院分区：
文献类型：
--
作者：
Dhanoa A;Fang NC;Hassan SS;Kaniappan P;Rajasekaram G
许多报告描述了2009年甲型H1N1流感感染患者的流行病学和临床特征。然而，关于细菌合并感染对这些患者的影响的数据非常少。因此，本研究探讨细菌共感染对H1N1住院患者临床和实验室参数的影响。这项回顾性研究涉及2009年9月至2010年5月间经实验室确诊的H1N1感染住院患者。获得相关临床资料及呼吸道或无菌部位细菌共感染的检测结果。多重PCR检测其他呼吸道病毒是否共存。对合并和未合并细菌感染患者进行比较。合并感染的发生率为34%；细菌感染14例（28%），病毒感染3例（6%）。肺炎支原体（n = 5）是最常见的细菌，其次是金黄色葡萄球菌（n = 3）。在单因素分析中，与细菌合并感染相关的临床因素为年龄50 ~ 50岁（p = 0.02）、合并症的存在（p = 0.04）、肝损害（p = 0.02）、并发症的发生（p = 0.004）和补充需氧量（p = 0.02）。细菌共感染患者白细胞增多（p = 0.02）和嗜中性粒细胞增多（p = 0.004）较高。多因素logistic回归分析显示，年龄0 ~ 50岁及合并并发症是细菌合并感染的预测因素。细菌合并感染在H1N1感染患者中并不罕见，在老年患者中更为常见，并与较高的并发症发生率相关。此外，作为临床结果的补充，如果在入院时发现中性粒细胞增多，临床医生需要有更高的怀疑指数，因为它可能表示细菌共感染。
Numerous reports have described the epidemiological and clinical characteristics of influenza A (H1N1) 2009 infected patients. However, data on the effects of bacterial coinfection on these patients are very scarce. Therefore, this study explores the impact of bacterial coinfection on the clinical and laboratory parameters amongst H1N1 hospitalized patients. This retrospective study involved hospitalized patients with laboratory-confirmed H1N1 infections (September 2009 to May 2010). Relevant clinical data and the detection of bacterial coinfection from respiratory or sterile site samples were obtained. Multiplex PCR was used to determine the co-existence of other respiratory viruses. Comparison was made between patients with and without bacterial coinfection. The occurrence of coinfection was 34%; 14 (28%) bacterial and only 3 (6%) viral. Mycoplasma pneumoniae (n = 5) was the commonest bacteria followed by Staphylococcus aureus (n = 3). In univariate analysis, clinical factors associated with bacterial coinfection were age > 50 years (p = 0.02), presence of comorbidity (p = 0.04), liver impairment (p = 0.02), development of complications (p = 0.004) and supplemental oxygen requirement (p = 0.02). Leukocytosis (p = 0.02) and neutrophilia (p = 0.004) were higher in bacterial coinfected patients. Multivariate logistic regression analysis revealed that age > 50 years and combined complications were predictive of bacterial coinfection. Bacterial coinfection is not uncommon in H1N1 infected patients and is more frequently noted in the older aged patients and is associated with higher rates of complications. Also, as adjunct to clinical findings, clinicians need to have a higher index of suspicion if neutrophilia was identified at admission as it may denote bacterial coinfection.