Bruxvoort Katia J, Fischer Heidi, Lewnard Joseph A, Hong Vennis X, Pomichowski Magdalena, Grant Lindsay R, Jódar Luis, Gessner Bradford D, Tartof Sara Y
Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.
Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 1665 University Blvd, Birmingham, AL, 35233, USA.
Pneumonia (Nathan). 2023 Oct 5;15(1):15. doi: 10.1186/s41479-023-00117-5.
Respiratory pathogens, including SARS-CoV-2, can cause pulmonary structural damage and physiologic impairment, which may increase the risk of subsequent lower respiratory tract infections (LRTI). Prior hospitalization for any reason is a risk factor for LRTI, but data on the risk of subsequent new-onset LRTI following hospitalization for COVID-19 LRTI or non-COVID-19 LRTI are needed to inform strategies for immunizations targeting respiratory pathogens.
We conducted a retrospective cohort study at Kaiser Permanente Southern California (KPSC) among adults hospitalized from 3/1/2020 to 5/31/2022, excluding labor and delivery. We categorized individuals into 3 mutually exclusive baseline exposure groups: those hospitalized for COVID-19 LRTI, those hospitalized for non-COVID-19 LRTI, and those hospitalized for all other causes without LRTI or COVID-19 ("non-LRTI"). Following hospital discharge, patients were followed up for new-onset LRTI, beginning 30 antibiotic-free days after hospital discharge until 8/31/2022. We used multivariable cause-specific Cox regression with time-varying covariates to estimate hazard ratios (HR) of new-onset LRTI comparing those hospitalized for COVID-19 LRTI or non-COVID-19 LRTI to those hospitalized for non-LRTI, adjusting for demographic and clinical characteristics.
The study included 22,417 individuals hospitalized for COVID-19 LRTI, 12,795 individuals hospitalized for non-COVID-19 LRTI, and 176,788 individuals hospitalized for non-LRTI. Individuals hospitalized for non-COVID-19 LRTI were older and had more comorbidities than those hospitalized for COVID-19 LRTI or non-LRTI. Incidence rates per 1,000 person-years (95% CI) of new-onset LRTI were 52.5 (51.4-53.6) among individuals hospitalized for COVID-19 LRTI, 253.5 (243.7-263.6) among those hospitalized for non-COVID-19 LRTI, and 52.5 (51.4-53.6) among those hospitalized for non-LRTI. The adjusted hazard of new-onset LRTI during follow-up was 20% higher among individuals hospitalized for COVID-19 LRTI (HR 1.20 [95% CI: 1.12-1.28]) and 301% higher among individuals hospitalized for non-COVID-19 LRTI (HR 3.01 [95% CI: 2.87-3.15]) compared to those hospitalized for non-LRTI.
The risk of new-onset LRTI following hospital discharge was high, particularly among those hospitalized for non-COVID-19 LRTI, but also for COVID-19 LRTI. These data suggest that immunizations targeting respiratory pathogens, including COVID-19, should be considered for adults hospitalized for LRTI prior to hospital discharge.
包括新型冠状病毒2（SARS-CoV-2）在内的呼吸道病原体可导致肺部结构损伤和生理功能损害，这可能会增加随后发生下呼吸道感染（LRTI）的风险。因任何原因既往住院是LRTI的一个危险因素，但需要关于因新型冠状病毒肺炎（COVID-19）相关LRTI或非COVID-19相关LRTI住院后发生新发性LRTI风险的数据，以为针对呼吸道病原体的免疫策略提供信息。
我们在南加州凯撒医疗集团（KPSC）进行了一项回顾性队列研究，研究对象为2020年3月1日至2022年5月31日期间住院的成年人，不包括分娩住院者。我们将个体分为3个相互排斥的基线暴露组：因COVID-19相关LRTI住院者、因非COVID-19相关LRTI住院者，以及因无LRTI或COVID-19的所有其他原因住院者（“非LRTI”）。出院后，对患者进行新发性LRTI随访，从出院后30个无抗生素使用日开始，直至2022年8月31日。我们使用具有时变协变量的多变量特定病因Cox回归，以估计因COVID-19相关LRTI或非COVID-19相关LRTI住院者与因非LRTI住院者相比发生新发性LRTI的风险比（HR），并对人口统计学和临床特征进行调整。
该研究纳入了22417例因COVID-19相关LRTI住院的个体、12795例因非COVID-19相关LRTI住院的个体，以及176788例因非LRTI住院的个体。因非COVID-19相关LRTI住院的个体比因COVID-19相关LRTI或非LRTI住院的个体年龄更大，合并症更多。每1000人年（95%CI）的新发性LRTI发病率在因COVID-19相关LRTI住院的个体中为52.5（51.4 - 53.6），在因非COVID-19相关LRTI住院的个体中为253.5（243.7 - 263.6），在因非LRTI住院的个体中为52.5（51.4 - 53.6）。与因非LRTI住院的个体相比，因COVID-19相关LRTI住院的个体在随访期间发生新发性LRTI的调整后风险高20%（HR 1.20 [95%CI：1.12 - 1.28]），因非COVID-19相关LRTI住院的个体高301%（HR 3.01 [95%CI：2.87 - 3.15]）。
出院后发生新发性LRTI的风险很高，特别是在因非COVID-19相关LRTI住院的个体中，但因COVID-19相关LRTI住院的个体中风险也较高。这些数据表明，对于因LRTI住院的成年人，应在出院前考虑针对包括COVID-19在内的呼吸道病原体进行免疫接种。
