Viasus Diego, Paño-Pardo José Ramón, Pachón Jerónimo, Riera Melchor, López-Medrano Francisco, Payeras Antoni, Fariñas M Carmen, Moreno Asunción, Rodríguez-Baño Jesús, Oteo José Antonio, Martínez-Montauti Joaquín, Torre-Cisneros Julián, Segura Ferrán, Gudiol Francesc, Carratalà Jordi
From Departments of Infectious Diseases, Hospital Universitari de Bellvitge-IDIBELL (DV, FG, JC), University of Barcelona (FG, JC), Hospital Universitario Clinic (AM), SCIAS-Hospital de Barcelona (JM-M), Barcelona; Hospital Universitario La Paz-IDIPAZ (JRP-P), Hospital Universitario 12 de Octubre (FL-M), Madrid; Hospital Universitario Virgen del Rocío (JP), Hospital Universitario Virgen Macarena (JR-B), Sevilla; Hospital Universitario Son Dureta (MR), Hospital Son Llàtzer (AP), Palma de Mallorca; Hospital Universitario Marqués de Valdecilla (MCF), Santander; Hospital San Pedro-CIBIR (JAO), Logroño; Hospital Universitario Reina Sofía-IMIBIC, University of Córdoba (JT-C), Córdoba; Hospital Parc Tauli (FS), Sabadell; Spain.
Medicine (Baltimore). 2011 Sep;90(5):328-336. doi: 10.1097/MD.0b013e31822e67a7.
We performed an observational analysis of a prospective cohort of adults hospitalized for pandemic (H1N1) 2009 at 13 Spanish hospitals, from June to November 2009, to determine the risk factors, clinical features, and outcomes of pneumonia. Of 585 patients requiring hospitalization, chest radiography was obtained in 542. A total of 234 (43.1%) patients had pneumonia, of whom 210 underwent bacterial microbiologic studies. Of these patients, 174 (82.8%) had primary viral pneumonia and 36 (17.2%) had concomitant/secondary bacterial pneumonia. Bilateral pneumonia occurred in 48.3% of patients. Streptococcus pneumoniae was the most frequent pathogen among patients with bacterial pneumonia (26 of 36 patients). None of them had received pneumococcal vaccine. Compared with patients without pneumonia, those with pneumonia more frequently had shock during hospitalization (9.8% vs. 1%; p < 0.001), required intensive care unit admission (22.6% vs. 5.8%; p < 0.001), underwent mechanical ventilation (17.9% vs. 3.2%; p < 0.001), and had longer length of hospital stay (median, 7 d vs. 5 d; p < 0.001). In-hospital mortality was higher in patients with pneumonia than in the others (5.2% vs. 0%; p < 0.001). Absence of comorbid conditions (odds ratio [OR], 2.07; 95% confidence interval [CI], 1.32-3.24) was found to be an independent risk factor for pneumonia, whereas early (≤ 48 h) oseltamivir therapy (OR, 0.29; 95% CI, 0.19-0.46) was a protective factor. In conclusion, pneumonia is a frequent complication among adults hospitalized for pandemic (H1N1) 2009 and causes significant morbidity. Mortality in pandemic (H1N1) 2009 is low, but occurs mainly in patients with pneumonia. Early oseltamivir therapy is a protective factor for this complication.
2009年6月至11月，我们对西班牙13家医院收治的因2009年甲型H1N1流感大流行而住院的成年患者前瞻性队列进行了观察性分析，以确定肺炎的危险因素、临床特征及转归。在585例需要住院治疗的患者中，542例进行了胸部X线检查。共有234例（43.1%）患者发生肺炎，其中210例接受了细菌学检查。这些患者中，174例（82.8%）为原发性病毒性肺炎，36例（17.2%）为合并/继发性细菌性肺炎。48.3%的患者发生双侧肺炎。肺炎链球菌是细菌性肺炎患者中最常见的病原体（36例患者中有26例）。他们均未接种过肺炎球菌疫苗。与未发生肺炎的患者相比，发生肺炎的患者在住院期间更频繁地出现休克（9.8%对1%；p<0.001）、需要入住重症监护病房（22.6%对5.8%；p<0.001）、接受机械通气（17.9%对3.2%；p<0.001），且住院时间更长（中位数分别为7天和5天；p<0.001）。肺炎患者的院内死亡率高于其他患者（5.2%对0%；p<0.001）。未合并其他疾病（比值比[OR]为2.07；95%置信区间[CI]为1.32 - 3.24）被发现是肺炎的独立危险因素，而早期（≤48小时）使用奥司他韦治疗（OR为0.29；95%CI为0.19 - 0.46）是一个保护因素。总之，肺炎是2009年甲型H1N1流感大流行住院成年患者的常见并发症，并导致显著的发病率。2009年甲型H1N1流感大流行的死亡率较低，但主要发生在肺炎患者中。早期奥司他韦治疗是该并发症的一个保护因素。
