Department of Medicine, Emory University School of Medicine, The Atlanta VA Medical Center, 1670 Clairmont Road, Mail Code 151-ID, Atlanta, GA 30333, USA.
J Infect. 2012 Dec;65(6):496-504. doi: 10.1016/j.jinf.2012.08.005. Epub 2012 Aug 15.
Introduction of the Haemophilus influenzae type b (Hib) conjugate vaccine has resulted in a dramatic reduction of Hib disease in the U.S. and an increase in the relative importance of infections caused by nontypeable strains. The current project describes the characteristics and clinical outcomes of pediatric and adult patients with invasive H. influenzae (HI) and, through multivariable analysis, identifies risk factors for in-hospital mortality.
HI cases were identified during 1999-2008 through active surveillance as part of active bacterial core surveillance (ABCs). Multivariable analysis was performed with logistic regression to identify factors predictive of in-hospital death.
4839 cases of HI were identified from 1999-2008. Children accounted for 17.1% of cases and adults 82.9%. Underlying conditions were present in 20.7% of children and 74.8% of adults. In-hospital mortality was highest in cases ≥65 years (21.9%) and <3 months (16.2%). The risk of in-hospital death in children <1 year was higher among those who were prematurely-born (<28 weeks, OR 7.1, 95% CI 3.2-15.6; 28-36 weeks OR 2.1, 95% CI 0.9-4.8) and, among children aged 1-17 years, higher in those with healthcare-associated onset and dialysis (OR 5.66, 95% CI 1.84-17.39; OR 18.11, 95% CI 2.77-118.65). In adults, age ≥40 was associated with death in nontypeable, but not encapsulated, infections. Infections with nontypeable strains increased the risk of death in cases ≥65 years (OR 1.81, 95% CI 1.31-2.52). Healthcare-associated HI, bacteremia without identifiable focus, bacteremic pneumonia, associated cirrhosis, cerebrovascular accident, dialysis, heart failure, and non-hematologic malignancy also increased the risk of death in adults.
Prematurity in infants, advanced age and certain chronic diseases in adults were associated with an increased risk of in-hospital death. Nontypeable HI was associated with higher mortality in the elderly.
乙型流感嗜血杆菌（Hib）结合疫苗的引入导致美国 Hib 疾病的发病率显著降低，而无荚膜菌株引起的感染的相对重要性增加。本研究通过多变量分析，描述了儿童和成人侵袭性流感嗜血杆菌（HI）患者的特征和临床结局，并确定了院内死亡的危险因素。
1999-2008 年期间，通过主动监测作为主动细菌核心监测（ABCs）的一部分，发现 HI 病例。采用逻辑回归进行多变量分析，以确定与院内死亡相关的因素。
1999-2008 年共发现 4839 例 HI 病例。儿童占 17.1%，成人占 82.9%。儿童中有 20.7%有基础疾病，成人中有 74.8%有基础疾病。年龄≥65 岁（21.9%）和＜3 个月（16.2%）的患者院内死亡率最高。＜1 岁的早产儿（＜28 周，OR7.1，95%CI3.2-15.6；28-36 周，OR2.1，95%CI0.9-4.8）和 1-17 岁儿童中与医疗保健相关的发病和透析（OR5.66，95%CI1.84-17.39；OR18.11，95%CI2.77-118.65）的死亡风险更高。成人中，年龄≥40 岁与无荚膜感染相关，而与荚膜感染无关。年龄≥65 岁时，无荚膜菌株感染增加死亡风险（OR1.81，95%CI1.31-2.52）。与医疗保健相关的 HI、无明确病灶的菌血症、菌血症性肺炎、相关肝硬化、脑血管意外、透析、心力衰竭和非血液系统恶性肿瘤也增加了成人的死亡风险。
婴儿早产、成人年龄较大和某些慢性疾病与院内死亡风险增加相关。无荚膜 HI 与老年人的死亡率较高有关。
