Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA.
Crit Care Med. 2012 Dec;40(12):3246-50. doi: 10.1097/CCM.0b013e318260c7f8.
H1N1 influenza with coinfections has been implicated to have high morbidity and mortality. We hypothesized that critically ill children with 2009 H1N1 and coinfections are at a higher risk of developing disseminated intravascular coagulation.
The chart review included demographics, length-of-stay, severity of illness score (Pediatric Risk of Mortality III acute physiology score), clinical laboratories, and outcomes at hospital day 90 data. Patients were classified as having methicillin-sensitive or -resistant Staphylococcus aureus, other, or no coinfections.
Single-center pediatric intensive care unit.
Sixty-six consecutive patients with 2009 H1N1 and influenza A infection.
None.
: There were 12, 22, and 32 patients with methicillin-sensitive or -resistant Staphylococcus aureus, other, and no coinfections, respectively. Pediatric critical care unit length-of-stay was 11, 10, and 5.5 days (median), and survival at day 90 was 83%, 96%, and 91% in patients with methicillin-sensitive or -resistant Staphylococcus aureus, other, and no coinfections. Patients with methicillin-sensitive or -resistant Staphylococcus aureus coinfections compared to patients with other, and no coinfections had higher Pediatric Risk of Mortality III acute physiology scores (14 [6-25] vs. 7 [2-10], p = .052 and 6 [2.5-10], p = .008; median [interquartile range]), higher D-dimer (16.1 [7.9-19.3] vs. 1.6 [1.1-4], p = .02 and 2.3 [0.8-8.7] µg/mL, p = .05), longer prothrombin time (19.3 [15.4-25.9] vs. 15.3 [14.8-17.1], p = .04 and 16.6 [14.7-20.4] secs, p < .39) at admission, and lower day-7 platelet counts (90K [26-161K] vs. 277K [98-314], p = .03 and 256K [152-339]/mm, p < .07). Patients with methicillin-sensitive or -resistant Staphylococcus aureus coinfections compared to patients without coinfections were more likely to be sicker with Pediatric Risk of Mortality III acute physiology score >10 vs. <10 (relative risk 2.4; 95% confidence interval 1.2-4.7; p = .035) and have overt disseminated intravascular coagulation (relative risk 4.4; 95% confidence interval 1.3-15.8, p = .025).
During the 2009-2010 H1N1 pandemic, pediatric patients with influenza A and methicillin-sensitive or -resistant Staphylococcus aureus coinfections were sicker and more likely to develop disseminated intravascular coagulation than patients with other or no coinfections.
已发现合并感染的 H1N1 流感具有较高的发病率和死亡率。我们假设，患有 2009 年 H1N1 流感和合并感染的危重病儿童发生弥漫性血管内凝血的风险更高。
该图表回顾包括人口统计学、住院时间、严重程度评分（小儿危重病评分 III 急性生理学评分）、临床实验室和第 90 天的住院数据。患者分为耐甲氧西林金黄色葡萄球菌敏感或耐药、其他或无合并感染。
单中心儿科重症监护病房。
66 例连续患有 2009 年 H1N1 流感和甲型流感感染的患者。
无。
耐甲氧西林金黄色葡萄球菌敏感或耐药、其他和无合并感染的患者分别为 12、22 和 32 例。儿科重症监护病房的住院时间分别为 11、10 和 5.5 天（中位数），耐甲氧西林金黄色葡萄球菌敏感或耐药、其他和无合并感染的患者在第 90 天的生存率分别为 83%、96%和 91%。与其他和无合并感染的患者相比，耐甲氧西林金黄色葡萄球菌敏感或耐药合并感染的患者的小儿危重病评分 III 急性生理学评分更高（14[6-25]比 7[2-10]，p=.052 和 6[2.5-10]，p=.008；中位数[四分位间距]），D-二聚体更高（16.1[7.9-19.3]比 1.6[1.1-4]，p=.02 和 2.3[0.8-8.7]μg/mL，p=.05），入院时凝血酶原时间更长（19.3[15.4-25.9]比 15.3[14.8-17.1]，p=.04 和 16.6[14.7-20.4]秒，p<.39），第 7 天血小板计数更低（90K[26-161K]比 277K[98-314]，p=.03 和 256K[152-339]/mm，p<.07）。与无合并感染的患者相比，耐甲氧西林金黄色葡萄球菌敏感或耐药合并感染的患者更容易出现小儿危重病评分 III 急性生理学评分>10 分与<10 分（相对风险 2.4；95%置信区间 1.2-4.7；p=.035），且更易发生显性弥漫性血管内凝血（相对风险 4.4；95%置信区间 1.3-15.8，p=.025）。
在 2009-2010 年 H1N1 大流行期间，患有甲型流感和耐甲氧西林金黄色葡萄球菌敏感或耐药合并感染的儿科患者比其他或无合并感染的患者病情更严重，且更易发生弥漫性血管内凝血。
