Smith Emma L, Tan Bryan, Bastas Alysia, Kotsanas Despina, Dendle Claire, Ojaimi Samar
Monash Infectious Diseases, Monash Health, Melbourne, Australia.
Monash University, Melbourne, Australia.
Open Forum Infect Dis. 2022 Jul 5;9(7):ofac330. doi: 10.1093/ofid/ofac330. eCollection 2022 Jul.
Invasive disease caused by airway pathogens, including , , , and , has high morbidity and mortality worldwide, with immunodeficiency being a known association with recurrent disease. The study aimed to describe the frequency of known immunodeficiency and predisposing factors in adult patients presenting with invasive infections and determine the frequency of screening for and detection of immunodeficiency.
A retrospective analysis was conducted at a large tertiary Australian health service, comprising multiple centers. Patients aged 18 years or older, in whom the above pathogens were isolated from sterile sites, were included as identified through a microbiology database, between 2015 and 2020. Using electronic medical records, patient demographics, medical history, outcomes of admission, and pathology results were captured and reviewed to address the aims.
In 252 patients, was the most common culprit, isolated in 73% (185/252), compared to 14.3% (36/252) and 11.5% (29/252) of infections caused by and , respectively. Known diagnoses of secondary immunodeficiency were common (31% of patients). Of those presenting with invasive pneumococcal disease, 78% had at least 1 predisposing condition, though only 9 patients (6%) had previously received pneumococcal vaccination. Despite poor screening for immunodeficiency, 12 new diagnoses were made. While the commonest immunodeficiency was secondary, due to hematological and solid organ malignancies, 3 new primary immunodeficiency diagnoses were made.
Immunodeficiency is common in this patient population. Screening should be undertaken to ensure timely diagnosis and treatment of the underlying condition to avoid future morbidity and mortality.
由气道病原体（包括[具体病原体1]、[具体病原体2]、[具体病原体3]和[具体病原体4]）引起的侵袭性疾病在全球范围内具有较高的发病率和死亡率，免疫缺陷是已知的与复发性疾病相关的因素。本研究旨在描述侵袭性感染成年患者中已知免疫缺陷和易感因素的频率，并确定免疫缺陷筛查和检测的频率。
在澳大利亚一家大型三级医疗服务机构（包括多个中心）进行了一项回顾性分析。纳入2015年至2020年期间通过微生物学数据库确定的18岁及以上患者，这些患者从无菌部位分离出上述病原体。利用电子病历获取并审查患者的人口统计学信息、病史、入院结局和病理结果，以实现研究目的。
在252例患者中，[具体病原体1]是最常见的病原体，73%（185/252）的患者分离出该病原体，相比之下，[具体病原体2]和[具体病原体3]引起的感染分别占14.3%（36/252）和11.5%（29/252）。继发性免疫缺陷的已知诊断很常见（占患者的31%）。在患有侵袭性肺炎球菌疾病的患者中，78%至少有一种易感状况，尽管只有9例患者（6%）之前接种过肺炎球菌疫苗。尽管免疫缺陷筛查不足，但仍做出了12例新的诊断。虽然最常见的免疫缺陷是继发性的，由血液系统和实体器官恶性肿瘤引起，但也做出了3例新的原发性免疫缺陷诊断。
免疫缺陷在该患者群体中很常见。应进行筛查以确保及时诊断和治疗潜在疾病，避免未来的发病和死亡。
