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[2岁以下住院患者下呼吸道病毒合并感染的短期相关性]

[Short-term relevance of lower respiratory viral coinfection in inpatients under 2 years of age].

作者信息

Gil Joana, Almeida Sofia, Constant Carolina, Pinto Sara, Barreto Rosário, Cristino José Melo, Machado Maria do Céu, Bandeira Teresa

机构信息

Unidad Respiratoria Pediátrica, Servicio de Pediatría, Hospital de Santa Maria-Centro Hospitalar Lisboa Norte EPE, Centro Académico de Medicina de Lisboa, Lisboa, Portugal.

Unidad Respiratoria Pediátrica, Servicio de Pediatría, Hospital de Santa Maria-Centro Hospitalar Lisboa Norte EPE, Centro Académico de Medicina de Lisboa, Lisboa, Portugal.

出版信息

An Pediatr (Engl Ed). 2018 Mar;88(3):127-135. doi: 10.1016/j.anpedi.2017.03.020. Epub 2017 May 29.

Abstract

INTRODUCTION

Advances in molecular diagnosis have made it possible to detect previously unknown viral agents as causative agents of lower respiratory tract infections (LRTI). The frequency and relevance of viral coinfections is still debatable.

OBJECTIVE

compare clinical presentation and severity between single virus infection and viral coinfection in children admitted for LRTI.

METHODS

A 3-year period observational study (2012-2015) included children younger than two years admitted for LRTI. Viral identification was performed using PCR technique for 16 viruses. Clinical data and use of health resources was gathered during hospital stay using a standard collection form and we compared single virus infection and viral coinfections.

RESULTS

The study included 524 samples (451 patients); 448 (85,5%) had at least one virus identified. Viral coinfections were found in 159 (35,5%). RSV and HRV were the most commonly identified virus; bronchiolitis and pneumonia the most frequent diagnosis. Patients with viral coinfections were older, attended day-care centers, had previous recurrent wheezing more frequently and were more symptomatic at admission. These patients did not have more complementary exams performed but were prescribed medications more often. Viral coinfection group did not show longer length of hospital stay and oxygen need, more need for ICU nor ventilatory support.

DISCUSSION

Our study showed a significant proportion of viral coinfections in young infants admitted with LRTI and confirmed previous data showing that prescription was more frequent in inpatients with viral coinfections, without an association with worst clinical outcome.

摘要

引言

分子诊断技术的进步使得检测出以前未知的作为下呼吸道感染(LRTI)病原体的病毒成为可能。病毒合并感染的频率及相关性仍存在争议。

目的

比较因LRTI入院的儿童中单一病毒感染与病毒合并感染之间的临床表现及严重程度。

方法

一项为期3年的观察性研究(2012 - 2015年)纳入了因LRTI入院的2岁以下儿童。采用PCR技术对16种病毒进行病毒鉴定。住院期间使用标准收集表收集临床数据及卫生资源使用情况,并比较单一病毒感染与病毒合并感染情况。

结果

该研究纳入了524份样本(451名患者);448份样本(85.5%)至少鉴定出一种病毒。发现159份样本(35.5%)存在病毒合并感染。呼吸道合胞病毒(RSV)和人鼻病毒(HRV)是最常鉴定出的病毒;细支气管炎和肺炎是最常见的诊断。病毒合并感染的患者年龄较大,去过日托中心,既往反复喘息更频繁,入院时症状更明显。这些患者进行的辅助检查并不更多,但用药更频繁。病毒合并感染组的住院时间、吸氧需求、入住重症监护病房(ICU)的需求及机械通气支持需求均未增加。

讨论

我们的研究显示,因LRTI入院的幼儿中病毒合并感染比例较高,并证实了先前的数据,即病毒合并感染的住院患者用药更频繁,但与更差的临床结局无关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9687/7185555/d2e568e234e9/gr1_lrg.jpg

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