Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan.
San Lazaro Hospital, Manila, The Philippines.
Int J Tuberc Lung Dis. 2018 Jan 1;22(1):65-72. doi: 10.5588/ijtld.17.0389.
To investigate the prevalence of bacterial co-infection and its effect on early mortality among hospitalised human immunodeficiency virus (HIV) negative pulmonary tuberculosis (PTB) patients in Manila, the Philippines.
A prospective observational study was conducted at a national infectious disease hospital. HIV-negative PTB patients aged 13 years hospitalised from November to December 2011 and from December 2012 to May 2013 were enrolled. Sputum samples were tested for Mycobacterium tuberculosis and six respiratory bacterial pathogens using polymerase chain reaction (PCR).
Of 466 patients, 228 (48.9%) were TB-PCR-positive. Overall, bacterial pathogens in purulent sputum were detected in 135 (29.0%) patients: Haemophilus influenzae was the most common bacterium (21.2%), followed by Streptococcus pneumoniae (7.9%). The prevalence of bacterial co-infection did not differ between TB-PCR-positive and -negative patients. A total of 92 (19.7%) patients died within 2 weeks. Bacterial co-infection was significantly associated with an increased risk of 2-week mortality among TB-PCR-positive patients (adjusted risk ratio [aRR] 1.67, 95%CI 1.03-2.72). This association was also observed but did not reach statistical significance among TB-PCR-negative patients (aRR1.7, 95%CI 0.95-3.02).
Bacterial co-infection is common and contributes to an increased risk of early mortality among HIV-negative PTB patients.
调查在菲律宾马尼拉住院的人类免疫缺陷病毒（HIV）阴性肺结核（PTB）患者中细菌合并感染的流行情况及其对早期死亡率的影响。
这是一项在一家国家传染病医院进行的前瞻性观察性研究。2011 年 11 月至 12 月和 2012 年 12 月至 2013 年 5 月期间，招募了年龄≥13 岁、因 PTB 住院的 HIV 阴性 PTB 患者。使用聚合酶链反应（PCR）检测痰液样本中的结核分枝杆菌和六种呼吸道细菌病原体。
在 466 名患者中，228 名（48.9%）患者的 TB-PCR 结果呈阳性。总体而言，135 名（29.0%）患者的脓性痰液中检测到细菌病原体：最常见的细菌是流感嗜血杆菌（21.2%），其次是肺炎链球菌（7.9%）。TB-PCR 阳性和阴性患者的细菌合并感染率没有差异。共有 92 名（19.7%）患者在 2 周内死亡。细菌合并感染与 TB-PCR 阳性患者 2 周死亡率增加显著相关（调整风险比[aRR]1.67，95%CI 1.03-2.72）。这一关联在 TB-PCR 阴性患者中也观察到，但没有达到统计学意义（aRR1.7，95%CI 0.95-3.02）。
细菌合并感染很常见，并且会增加 HIV 阴性 PTB 患者早期死亡的风险。
