Lim Wei Shen, Macfarlane John T, Colthorpe Charlotte L
Respiratory Infection Research Group, Respiratory Medicine, Nottingham City Hospital, Nottingham, UK.
Am J Respir Med. 2003;2(3):221-33. doi: 10.1007/BF03256651.
The incidence of lower respiratory tract infection (LRTI) in women of child-bearing age is approximately 64 per 1000 population. The spectrum of illness ranges from acute bronchitis, which is very common, through influenza virus infection and exacerbations of underlying lung disease, to pneumonia, which, fortunately is uncommon (<1.5% LRTI), but can be severe. Acute bronchitis is generally mild, self-limiting and usually does not require antibacterial therapy. Influenza virus infection in pregnant women has been recently related to increased hospitalization for acute cardiorespiratory conditions. At present, the safety of the newer neuraminidase inhibitors for the treatment of influenza virus infection has not been established in pregnancy and they are not routinely recommended. In influenza virus infection complicated by pneumonia, antibacterial agents active against Staphylococcus aureus and Streptococcus pneumoniae superinfection should be used. There are few data on infective complications of asthma or COPD in pregnancy. The latter is rare, as patients with COPD are usually male and aged over 45 years. Management is the same as for nonpregnant patients. The incidence and mortality of pneumonia in pregnancy is similar to that in nonpregnant patients. Infants born to pregnant patients with pneumonia have been found to be born earlier and weigh less than controls. Risk factors for the development of pneumonia include anemia, asthma and use of antepartum corticosteroids and tocolytic agents. Based on the few available studies, the main pathogens causing pneumonia are S. pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae and viruses. Beta-Lactam and macrolide antibiotics therefore remain the antibiotics of choice in terms of both pathogen coverage and safety in pregnancy. In HIV-infected pregnant patients, recurrent bacterial pneumonia, but not Pneumocystis carinii pneumonia (PCP), is more common than in nonpregnant patients. Trimethoprim/sulfamethoxazole (cotrimoxazole) has not definitely been associated with adverse clinical outcomes despite theoretical risks. Currently it is still the treatment of choice in PCP, where mortality remains high. In conclusion, there are few data specifically related to pregnant women with different types of LRTI. Where data are available, no significant differences compared with nonpregnant patients have been identified. In considering the use of any therapeutic agent or investigation in pregnant patients with LRTI, safety aspects must be carefully weighed against potential benefit. Otherwise, management strategies should not differ from those for nonpregnant patients. Further research in this area is warranted.
育龄期女性下呼吸道感染（LRTI）的发病率约为每1000人中有64例。疾病谱范围从非常常见的急性支气管炎，到流感病毒感染和潜在肺部疾病的加重，再到肺炎（幸运的是肺炎不常见，占LRTI的<1.5%），但可能很严重。急性支气管炎通常症状轻微，具有自限性，通常不需要抗菌治疗。孕妇感染流感病毒最近与急性心肺疾病住院率增加有关。目前，新型神经氨酸酶抑制剂用于治疗孕妇流感病毒感染的安全性尚未确立，因此不常规推荐使用。在并发肺炎的流感病毒感染中，应使用对金黄色葡萄球菌和肺炎链球菌超感染有效的抗菌药物。关于孕期哮喘或慢性阻塞性肺疾病（COPD）感染并发症的数据很少。COPD在孕期很少见，因为COPD患者通常为男性且年龄超过45岁。其管理与非孕期患者相同。孕期肺炎的发病率和死亡率与非孕期患者相似。已发现患肺炎的孕妇所生婴儿出生较早且体重低于对照组。肺炎发生的危险因素包括贫血、哮喘以及产前使用皮质类固醇和宫缩抑制剂。基于现有的少量研究，引起肺炎的主要病原体是肺炎链球菌、流感嗜血杆菌、肺炎支原体和病毒。因此，就病原体覆盖范围和孕期安全性而言，β-内酰胺类和大环内酯类抗生素仍然是首选抗生素。在感染人类免疫缺陷病毒（HIV）的孕妇中，复发性细菌性肺炎比非孕期患者更常见，但卡氏肺孢子虫肺炎（PCP）并非如此。尽管理论上存在风险，但甲氧苄啶/磺胺甲恶唑（复方新诺明）尚未明确与不良临床结局相关。目前，它仍是PCP的首选治疗药物，PCP的死亡率仍然很高。总之，关于患有不同类型LRTI的孕妇的具体数据很少。在有数据的情况下，与非孕期患者相比未发现显著差异。在考虑对患有LRTI的孕妇使用任何治疗药物或进行检查时，必须仔细权衡安全性与潜在益处。否则，管理策略不应与非孕期患者不同。该领域有必要进行进一步研究。
