Department of Hospital Infection Control, The First Affiliated Hospital of Chongqing Medical University, You Yi Road 1, Chongqing, 400016, China.
Department of Disease Prevention and Health Protection, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Antimicrob Resist Infect Control. 2023 Mar 31;12(1):25. doi: 10.1186/s13756-023-01234-y.
Secondary bacterial pneumonia is an important complication of seasonal influenza, but little data is available about impact on death and risk factors. This study identified risk factors for all-cause in-hospital mortality and secondary bacterial pneumonia among hospitalized adult patients with community-acquired influenza.
A retrospective cohort study was performed at a tertiary teaching hospital in southwest China. The study cohort included all adult hospitalized patients with a laboratory-confirmed, community-acquired influenza virus infection during three consecutive influenza seasons from 2017 to 2020. Cause-specific Cox regression was used to analyze risk factors for mortality and secondary bacterial pneumonia, respectively, accounting for competing events (discharge alive and discharge alive or death without secondary bacterial pneumonia, respectively).
Among 174 patients enrolled in this study, 14.4% developed secondary bacterial pneumonia and 11.5% died during hospitalization. For all-cause in-hospital mortality, time-varying secondary bacterial pneumonia was a direct risk factor of death (cause-specific hazard ratio [csHR] 3.38, 95% confidence interval [CI] 1.25-9.17); underlying disease indirectly increased death risk through decreasing the hazard of being discharged alive (csHR 0.55, 95% CI 0.39-0.77). For secondary bacterial pneumonia, the final model only confirmed direct risk factors: age ≥ 65 years (csHR 2.90, 95% CI 1.27-6.62), male gender (csHR 3.78, 95% CI 1.12-12.84) and mechanical ventilation on admission (csHR 2.96, 95% CI 1.32-6.64).
Secondary bacterial pneumonia was a major risk factor for in-hospital mortality among adult hospitalized patients with community-acquired influenza. Prevention strategies for secondary bacterial pneumonia should target elderly male patients and critically ill patients under mechanical ventilation.
继发性细菌性肺炎是季节性流感的一个重要并发症，但关于其对死亡的影响和危险因素的数据很少。本研究旨在确定住院成人社区获得性流感患者中全因院内死亡率和继发性细菌性肺炎的危险因素。
这是一项在中国西南部一家三级教学医院进行的回顾性队列研究。研究队列包括 2017 年至 2020 年连续三个流感季节期间实验室确诊的社区获得性流感病毒感染的所有成年住院患者。分别使用竞争风险 Cox 回归分析死亡率和继发性细菌性肺炎的危险因素，分别考虑竞争事件（存活出院和存活出院或无继发性细菌性肺炎死亡）。
在这项研究中，174 名患者中，14.4%发生继发性细菌性肺炎，11.5%在住院期间死亡。对于全因院内死亡率，继发性细菌性肺炎是死亡的直接危险因素（特异性危害比 [csHR] 3.38，95%置信区间 [CI] 1.25-9.17）；基础疾病通过降低存活出院的风险间接增加死亡风险（csHR 0.55，95% CI 0.39-0.77）。对于继发性细菌性肺炎，最终模型仅确认了直接危险因素：年龄≥65 岁（csHR 2.90，95% CI 1.27-6.62）、男性（csHR 3.78，95% CI 1.12-12.84）和入院时接受机械通气（csHR 2.96，95% CI 1.32-6.64）。
继发性细菌性肺炎是社区获得性流感住院成年患者院内死亡率的主要危险因素。继发性细菌性肺炎的预防策略应针对老年男性患者和接受机械通气的危重症患者。
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