Réanimation polyvalente.
Département d'Informatique Clinique.
Medicine (Baltimore). 2021 Jan 29;100(4):e24524. doi: 10.1097/MD.0000000000024524.
This study aimed to evaluate the incidence of co-infection with different types of pathogens in patients with hypoxemic pneumonia due to coronavirus disease 2019 (COVID-19) in Reunion Island.This observational study using a prospectively collected database of hypoxemic pneumonia due to COVID-19 cases was conducted at Félix Guyon University Hospital in Reunion Island, France.Between 18 March 2020 and 15 April 2020, 156 patients were admitted to our hospital for COVID-19. A total of 36 patients had hypoxemic pneumonia (23.1%) due to COVID-19. Thirty of these cases (83.3%) were imported by travelers returning mainly from metropolitan France and Spain. Patients were screened for co-infection with other pathogens at admission: 31 (86.1%) by multiplex polymerase chain reaction (PCR) and 16 (44.4%) by cytobacteriological examination of sputum culture. Five patients (13.9%) were found to have co-infection: 1 with influenza virus A H1N1 (pdm09) associated with Branhamella catarrhalis, 1 with Streptococcus pneumoniae associated with Haemophilus influenzae, 1 with Human Coronavirus 229E, 1 with Rhinovirus, and 1 with methicillin-susceptible Staphylococcus aureus. Patients with co-infection had higher D-dimer levels than those without co-infection (1.36 [1.34-2.36] μg/mL vs 0.63 [0.51-1.12] μg/mL, P = .05).The incidence of co-infection in our cohort was higher than expected (13.9%). Three co-infections (with influenza virus A(H1N1) pdm09, Streptococcus pneumoniae, and Staphylococcus aureus) required specific treatment. Patients with hypoxemic pneumonia due to COVID-19 should be screened for co-infection using respiratory cultures or multiplex PCR. Whilst our study has a number of limitations, the results from our study suggest that in the absence of screening, patients should be commenced on treatment for co-infection in the presence of an elevated D-dimer.
本研究旨在评估法属留尼汪岛因 2019 年冠状病毒病（COVID-19）导致低氧性肺炎的患者合并感染不同病原体的发生率。这是一项在法属留尼汪岛费利克斯·盖永大学医院进行的观察性研究，使用了 COVID-19 低氧性肺炎病例的前瞻性数据库。2020 年 3 月 18 日至 4 月 15 日期间，共有 156 名患者因 COVID-19 住院。共有 36 名患者（23.1%）因 COVID-19 合并低氧性肺炎。其中 30 例（83.3%）由主要从法国本土和西班牙返回的旅行者输入。在入院时对所有患者进行了合并感染其他病原体的筛查：31 例（86.1%）采用多重聚合酶链反应（PCR），16 例（44.4%）采用痰培养的细胞细菌学检查。发现 5 例（13.9%）合并感染：1 例甲型流感病毒 H1N1（pdm09）合并卡他莫拉菌，1 例肺炎链球菌合并流感嗜血杆菌，1 例人冠状病毒 229E，1 例鼻病毒，1 例耐甲氧西林金黄色葡萄球菌。合并感染者的 D-二聚体水平高于未合并感染者（1.36[1.34-2.36]μg/mL 比 0.63[0.51-1.12]μg/mL，P=0.05）。本队列的合并感染发生率高于预期（13.9%）。三种合并感染（甲型流感病毒 H1N1（pdm09）、肺炎链球菌和金黄色葡萄球菌）需要特殊治疗。COVID-19 导致低氧性肺炎的患者应使用呼吸道培养或多重 PCR 筛查合并感染。尽管本研究存在一些局限性，但研究结果表明，在没有筛查的情况下，如果 D-二聚体升高，应开始针对合并感染进行治疗。
