Section of Pediatric Emergency Medicine, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada.
Departments of Pediatrics and of Community Health Sciences, Cumming School of Medicine, Faculty of Kinesiology, Alberta Children's Hospital Research Institute, O'Brien Population Health Institute, University of Calgary, Calgary, Alberta, Canada.
Clin Microbiol Infect. 2019 Apr;25(4):454-461. doi: 10.1016/j.cmi.2018.06.016. Epub 2018 Jun 28.
To evaluate the relationship between individual bacterial and viral pathogens and disease severity.
Children <18 years with three or more episodes of vomiting and/or diarrhoea were enrolled in two Canadian paediatric emergency departments between December 2014 and August 2016. Specimens were analysed employing molecular panels, and outcome data were collected 14 days after enrolment. The primary outcome was severe disease over the entire illness (symptom onset until 14-day follow-up), quantified employing the Modified Vesikari Scale (MVS) score. The score was additionally analysed in two other time periods: index (symptom onset until enrolment) and follow-up (enrolment until 14-day follow-up).
Median participant age was 20.7 (IQR: 11.3, 44.2) months; 47.4% (518/1093) and 73.4% (802/1093) of participants had index and total MVS scores ≥11, respectively. The most commonly identified pathogens were rotavirus (289/1093; 26.4%) and norovirus (258/1093; 23.6%). In multivariable analysis, severe disease over the entire illness was associated with rotavirus (OR = 9.60; 95%CI: 5.69, 16.19), Salmonella (OR = 6.61; 95%CI: 1.50, 29.17), adenovirus (OR = 2.53; 95%CI: 1.62, 3.97), and norovirus (OR = 1.43; 95%CI: 1.01, 2.01). Pathogens associated with severe disease at the index visit were: rotavirus only (OR = 6.13; 95%CI: 4.29, 8.75), Salmonella (OR = 4.59; 95%CI: 1.71, 12.29), adenovirus only (OR = 2.06; 95%CI: 1.41, 3.00), rotavirus plus adenovirus (OR = 3.15; 95%CI: 1.35, 7.37), and norovirus (OR = 0.68; 95%CI: 0.49, 0.94). During the follow-up period, rotavirus (OR = 2.21; 95%CI: 1.50, 3.25) and adenovirus (OR = 2.10; 95%CI: 1.39, 3.18) were associated with severe disease.
In children presenting for emergency department care with acute gastroenteritis, pathogens identified were predominantly viruses, and several of which were associated with severe disease. Salmonella was the sole bacterium independently associated with severe disease.
评估个体细菌和病毒病原体与疾病严重程度之间的关系。
2014 年 12 月至 2016 年 8 月，在加拿大两家儿科急诊部门招募了 18 岁以下出现 3 次或以上呕吐和/或腹泻的儿童。采用分子面板分析标本，并在入组后 14 天收集结局数据。主要结局是整个疾病过程中（从症状发作到 14 天随访）的严重疾病，采用改良 Vesikari 量表（MVS）评分进行量化。该评分还在另外两个时间段进行了分析：指数（症状发作到入组）和随访（入组到 14 天随访）。
中位参与者年龄为 20.7（IQR：11.3，44.2）个月；47.4%（518/1093）和 73.4%（802/1093）的参与者指数和总 MVS 评分分别≥11。最常见的病原体是轮状病毒（289/1093；26.4%）和诺如病毒（258/1093；23.6%）。多变量分析显示，整个疾病过程中的严重疾病与轮状病毒（OR=9.60；95%CI：5.69，16.19）、沙门氏菌（OR=6.61；95%CI：1.50，29.17）、腺病毒（OR=2.53；95%CI：1.62，3.97）和诺如病毒（OR=1.43；95%CI：1.01，2.01）相关。与指数就诊时严重疾病相关的病原体为：仅轮状病毒（OR=6.13；95%CI：4.29，8.75）、沙门氏菌（OR=4.59；95%CI：1.71，12.29）、仅腺病毒（OR=2.06；95%CI：1.41，3.00）、轮状病毒加腺病毒（OR=3.15；95%CI：1.35，7.37）和诺如病毒（OR=0.68；95%CI：0.49，0.94）。在随访期间，轮状病毒（OR=2.21；95%CI：1.50，3.25）和腺病毒（OR=2.10；95%CI：1.39，3.18）与严重疾病相关。
在因急性胃肠炎到急诊就诊的儿童中，鉴定出的病原体主要为病毒，其中一些与严重疾病相关。沙门氏菌是唯一与严重疾病独立相关的细菌。
