Wesfarmers Centre of Vaccine and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia.
School of Paediatrics and Child Health, The University of Western Australia, Perth, Western Australia, Australia.
Respirology. 2016 May;21(4):648-55. doi: 10.1111/resp.12741. Epub 2016 Feb 25.
Respiratory infections are a common cause of paediatric morbidity. Clinical outcomes in children hospitalized with single respiratory virus infection are compared with those with two or more viral-viral coinfection. Studies were restricted to those reporting on children aged less than 5 years (PROSPERO CRD#42014009133). Published data to calculate risk ratios (RR) comparing children with single viral infections to coinfection using a random effects model were used. Similar analyses by pathogen pairs and by excluding children with comorbidities were performed. Of 4443 articles reviewed, 19 were included. Overall, no differences in the risk of fever, admission to an intensive care unit (ICU), oxygen use, mechanical ventilation and abnormal radiographs between children with single infection and those with coinfection were found. When analysing only children without comorbidities, the risk of fever (RR = 1.16 to RR = 1.24, 95% confidence intervals (CI) = 1.00-1.55) and ICU admission (RR = 1.08 to RR = 1.31, 95% CI = 0.93-1.83) increased but remained non-significant. Point estimates suggested an increased risk of ICU admission in those coinfected with either respiratory syncytial virus or human metapneumovirus compared with those with single infection but was non-significant. Our findings suggest that coinfection is not associated with increased clinical severity, but further investigations by pathogen pairs are warranted.
呼吸道感染是儿童发病的常见原因。本文比较了因单一呼吸道病毒感染住院的儿童与合并两种或两种以上病毒混合感染的儿童的临床结局。研究仅限于报告年龄小于 5 岁儿童的研究（PROSPERO CRD#42014009133）。使用随机效应模型，利用已有发表数据来计算比较单一病毒感染与混合感染儿童的风险比（RR）。同时还按病原体对和排除合并症儿童进行了类似的分析。在对 4443 篇文章进行综述后，纳入了 19 篇文章。总体而言，在单一感染和混合感染儿童之间，发热、入住重症监护病房（ICU）、使用氧气、机械通气和异常 X 光的风险没有差异。在仅分析无合并症的儿童时，发热（RR=1.16 至 RR=1.24，95%置信区间（CI）=1.00-1.55）和 ICU 入住（RR=1.08 至 RR=1.31，95%CI=0.93-1.83）的风险增加，但仍无统计学意义。点估计表明，与单一感染相比，呼吸道合胞病毒或人偏肺病毒混合感染的儿童 ICU 入住风险增加，但无统计学意义。我们的研究结果表明，混合感染与临床严重程度增加无关，但需要进一步按病原体对进行研究。
