肺炎和继发性细菌感染在甲型 H1N1pdm09 流感大流行中导致的致死和重症结局中的作用。
The role of pneumonia and secondary bacterial infection in fatal and serious outcomes of pandemic influenza a(H1N1)pdm09.
机构信息
Biosecurity Program, The Kirby Institute, UNSW Medicine, University of New South Wales, Sydney, NSW, 2052, Australia.
School of Public Health and Community Medicine, Faculty of Medicine, UNSW Medicine, the University of New South Wales, Samuels Building, Room 209, Sydney, NSW, 2052, Australia.
出版信息
BMC Infect Dis. 2018 Dec 7;18(1):637. doi: 10.1186/s12879-018-3548-0.
BACKGROUND
The aim of this study was to estimate the prevalence of pneumonia and secondary bacterial infections during the pandemic of influenza A(H1N1)pdm09.
METHODS
A systematic review was conducted to identify relevant literature in which clinical outcomes of pandemic influenza A(H1N1)pdm09 infection were described. Published studies (between 01/01/2009 and 05/07/2012) describing cases of fatal or hospitalised A(H1N1)pdm09 and including data on bacterial testing or co-infection.
RESULTS
Seventy five studies met the inclusion criteria. Fatal cases with autopsy specimen testing were reported in 11 studies, in which any co-infection was identified in 23% of cases (Streptococcus pneumoniae 29%). Eleven studies reported bacterial co-infection among hospitalised cases of A(H1N1)2009pdm with confirmed pneumonia, with a mean of 19% positive for bacteria (Streptococcus pneumoniae 54%). Of 16 studies of intensive care unit (ICU) patients, bacterial co-infection identified in a mean of 19% of cases (Streptococcus pneumoniae 26%). The mean prevalence of bacterial co-infection was 12% in studies of hospitalised patients not requiring ICU (Streptococcus pneumoniae 33%) and 16% in studies of paediatric patients hospitalised in general or pediatric intensive care unit (PICU) wards (Streptococcus pneumoniae 16%).
CONCLUSION
We found that few studies of the 2009 influenza pandemic reported on bacterial complications and testing. Of studies which did report on this, secondary bacterial infection was identified in almost one in four patients, with Streptococcus pneumoniae the most common bacteria identified. Bacterial complications were associated with serious outcomes such as death and admission to intensive care. Prevention and treatment of bacterial secondary infection should be an integral part of pandemic planning, and improved uptake of routine pneumococcal vaccination in adults with an indication may reduce the impact of a pandemic.
背景
本研究旨在评估甲型 H1N1pdm09 流感大流行期间肺炎和继发性细菌感染的流行情况。
方法
系统回顾以确定描述甲型 H1N1pdm09 感染临床结局的相关文献。发表的研究（2009 年 1 月 1 日至 2012 年 5 月 7 日）描述了致命或住院的 A(H1N1)pdm09 病例，并包括细菌检测或合并感染的数据。
结果
符合纳入标准的 75 项研究。在 11 项研究中报告了有尸检标本检测的致命病例，其中 23%的病例（肺炎链球菌 29%）确定存在合并感染。11 项报告了合并有确诊肺炎的住院 A(H1N1)2009pdm 病例的细菌合并感染，平均 19%的病例细菌检测阳性（肺炎链球菌 54%）。在 16 项 ICU 患者研究中，平均 19%的病例（肺炎链球菌 26%）确定存在细菌合并感染。在不需要 ICU 的住院患者研究中，细菌合并感染的平均发生率为 12%（肺炎链球菌 33%），在普通或儿科 ICU 病房住院的儿科患者研究中，细菌合并感染的平均发生率为 16%（肺炎链球菌 16%）。
结论
我们发现，2009 年流感大流行的研究很少报告细菌并发症和检测情况。在报告了这方面情况的研究中，近四分之一的患者确定存在继发性细菌感染，最常见的细菌是肺炎链球菌。细菌并发症与严重结局（如死亡和入住 ICU）相关。细菌继发性感染的预防和治疗应成为大流行规划的一个组成部分，对有指征的成人常规接种肺炎球菌疫苗可能会降低大流行的影响。
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