新型冠状病毒肺炎患者合并感染和继发感染的临床和病因学分析：一项观察性研究。
Clinical and etiological analysis of co-infections and secondary infections in COVID-19 patients: An observational study.
机构信息
Department of Clinical Laboratory, Shenzhen Third People's Hospital, Southern University of Science and Technology, National Clinical Research Center for Infectious Diseases, Shenzhen, China.
出版信息
Clin Respir J. 2021 Jul;15(7):815-825. doi: 10.1111/crj.13369. Epub 2021 Apr 19.
BACKGROUND
Co-infections, secondary bacterial or fungal infections, are important risk factors for poor outcomes in viral infections. The prevalence of co-infection and secondary infection in patients infected with SARS-CoV-2 is not well understood.
AIMS
To investigate the role of co-infections and secondary infections in disease severity of hospitalized individuals with COVID-19.
MATERIALS AND METHODS
A retrospective study was carried out between 11 January 2020 and 1 March 2020 among 408 laboratory confirmed COVID-19 patients in China. These patients were divided into three groups based on disease severity: mild or moderate, severe, or critically ill. Microbiological pathogens in blood, urine, and respiratory tract specimens were detected by the combination of culture, serology, polymerase chain reaction, and metagenomic next-generation sequencing (mNGS).
RESULTS
The median age of participants was 48 years (IQR 34-60 years). Fifty-two patients (12.7%) had at least one additional pathogen, 8.1% were co-infected, and 5.1% had a secondary infection. There were 13 Mycoplasma pneumoniae cases, 8 Haemophilus influenzae cases, 8 respiratory viruses, and 3 Streptococcus pneumoniae cases, primarily detected in mild and moderate COVID-19 patients. Hospital-acquired infection pathogens were more common in critically ill patients. Compared to those without additional pathogens, patients with co-infections and/or secondary infections were more likely to receive antibiotics (p < 0.001) and have elevated levels of d-dimer (p = 0.0012), interleukin-6 (p = 0.0027), and procalcitonin (p = 0.0002). The performance of conventional culture was comparable with that of mNGS in diagnosis of secondary infections.
CONCLUSION
Co-infections and secondary infections existed in hospitalized COVID-19 patients and were relevant to the disease severity. Screening of common respiratory pathogens and hospital infection control should be strengthened.
背景
合并感染，即继发细菌或真菌感染，是导致病毒感染不良预后的重要危险因素。目前尚不清楚 SARS-CoV-2 感染患者合并感染和继发感染的发生率。
目的
研究合并感染和继发感染在住院 COVID-19 患者疾病严重程度中的作用。
材料与方法
这是一项回顾性研究，于 2020 年 1 月 11 日至 3 月 1 日在中国进行，共纳入 408 例实验室确诊的 COVID-19 患者。这些患者根据疾病严重程度分为三组：轻症或普通型、重症和危重症。通过培养、血清学、聚合酶链反应和宏基因组下一代测序（mNGS）相结合的方法检测血液、尿液和呼吸道标本中的微生物病原体。
结果
参与者的中位年龄为 48 岁（IQR 34-60 岁）。52 例（12.7%）至少合并感染一种其他病原体，8.1%为合并感染，5.1%为继发感染。有 13 例肺炎支原体病例、8 例流感嗜血杆菌病例、8 例呼吸道病毒病例和 3 例肺炎链球菌病例，主要见于轻症和普通型 COVID-19 患者。医院获得性感染病原体在危重症患者中更为常见。与无其他病原体的患者相比，合并感染和/或继发感染的患者更有可能接受抗生素治疗（p < 0.001），且 d-二聚体（p = 0.0012）、白细胞介素-6（p = 0.0027）和降钙素原（p = 0.0002）水平升高。传统培养在诊断继发感染方面的表现与 mNGS 相当。
结论
住院 COVID-19 患者存在合并感染和继发感染，与疾病严重程度相关。应加强对常见呼吸道病原体的筛查和医院感染控制。
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