重症肺炎患者肺部产氨微生物的流行病学和临床特征：一项多中心队列研究
Epidemiological and clinical characteristics of ammonia-producing microorganisms in the lungs of patients with severe pneumonia: a multicentre cohort study.
作者信息
Xu Jun, Ren Xindie, Huang Xiaohan, Jin Yue, Wang Mingqiang, Zhong Lin, He Guojun, Wang Shengfeng, Wang Qianqian, Dai Muhua, Xiong Yonghui, Xu Yinghe, He Xuwei, Pan Yujie, Wang Hongyu, Xia Qi, Shao Huanzhang, Huang Lingtong, Cai Hongliu
机构信息
Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of Critical Care Medicine, Xinxiang Medical University, Henan Provincial People's Hospital, Zhengzhou, China.
出版信息
J Transl Med. 2024 Dec 26;22(1):1148. doi: 10.1186/s12967-024-05974-2.
BACKGROUND
Ureaplasma urealyticum, Ureaplasma parvum, and Mycoplasma hominis were widely known as ammonia-producing microorganisms and can cause hyperammonemia, leading to cerebral edema and altered consciousness, which represent serious complications in lung transplant recipients. However, there is limited knowledge on the epidemiology and outcomes of infections caused by U. urealyticum, U. parvum, and M. hominis in non-transplant patients with severe pneumonia in the ICU.
METHODS
Patients with severe pneumonia who underwent clinical metagenomics of bronchoalveolar lavage fluid (BALF) at the intensive care units (ICUs) of 17 medical centers from January 2019 to March 2023 were enrolled. All cases were divided into the positive group and the negative group based on whether U. urealyticum, U. parvum, or M. hominis was detected in lower respiratory tract. The clinical characteristics and outcomes were compared among the groups. The survival analysis after propensity score matching (PSM) was used to evaluate whether the mortality rate of U. urealyticum, U. parvum, and M. hominis positive patients were increased. Multivariate logistic regression was used to evaluate whether these microbials positivity were a risk factor for central nervous system dysfunction.
RESULTS
In a total number of 1737 patients, 55 patients (3.17%) in the positive group and 1682 patients (96.83%) in the negative group. Patients in the positive group were younger, had a greater proportion of male patients, and had a longer time from ICU admission to clinical metagenomics testing. In contrast, the negative group had a higher proportion of patients with cerebrovascular disease. After PSM, there was no statistically significant difference in 28-day mortality following ICU admission between the two groups (hazard ratio [HR], 0.842; 95% confidence interval [CI], 0.489-1.451; p = 0.536). Multivariate logistic regression analysis showed an association between the detection of U. urealyticum, U. parvum, or M. hominis and neurological dysfunction (odds ratio [OR], 1.84; 95% CI 1.04-3.24; p = 0.035).
CONCLUSION
The detection of U. urealyticum, U. parvum, or M. hominis in the lungs of patients is associated with neurological dysfunction.
背景
解脲脲原体、微小脲原体和人型支原体是广为人知的产氨微生物，可导致高氨血症，进而引起脑水肿和意识改变，这些在肺移植受者中属于严重并发症。然而，关于解脲脲原体、微小脲原体和人型支原体在重症监护病房（ICU）非移植重症肺炎患者中引起感染的流行病学和结局的了解有限。
方法
纳入2019年1月至2023年3月在17个医疗中心的ICU接受支气管肺泡灌洗液（BALF）临床宏基因组学检测的重症肺炎患者。根据下呼吸道是否检测到解脲脲原体、微小脲原体或人型支原体，将所有病例分为阳性组和阴性组。比较两组的临床特征和结局。采用倾向评分匹配（PSM）后的生存分析来评估解脲脲原体、微小脲原体和人型支原体阳性患者的死亡率是否增加。多因素逻辑回归用于评估这些微生物阳性是否是中枢神经系统功能障碍的危险因素。
结果
总共1737例患者中，阳性组55例（3.17%），阴性组1682例（96.83%）。阳性组患者更年轻，男性患者比例更高，从入住ICU到进行临床宏基因组学检测的时间更长。相比之下，阴性组脑血管疾病患者比例更高。PSM后，两组入住ICU后28天死亡率无统计学显著差异（风险比[HR]，0.842；95%置信区间[CI]，0.489 - 1.451；p = 0.536）。多因素逻辑回归分析显示，解脲脲原体、微小脲原体或人型支原体的检测与神经功能障碍之间存在关联（比值比[OR]，1.84；95% CI 1.04 - 3.24；p = 0.035）。
结论
患者肺部检测到解脲脲原体、微小脲原体或人型支原体与神经功能障碍有关。
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