背景:严重急性呼吸道感染(SARI),一个重大的全球健康问题,造成了巨大的疾病负担。在中国,关于呼吸道病原体监测的数据不足,特别是细菌,在SARI患者中。因此,这项研究旨在描述人口统计学,流行病学,2018年至2020年华中地区住院SARI患者的病因特征。
方法:本次回顾性研究纳入2018年1月1日至2020年12月31日郑州大学第一附属医院收治的SARI患者。在入院的第一个24小时内,呼吸道(包括痰,鼻/喉拭子,支气管肺泡灌洗液,胸腔穿刺液,等。),尿液,收集外周血标本进行病毒和细菌检测。多重实时聚合酶链反应(PCR)诊断方法用于鉴定人流感病毒,呼吸道合胞病毒,副流感病毒,腺病毒,人类博卡病毒,人类冠状病毒,人类偏肺病毒,和鼻病毒。呼吸道标本的细菌培养特别关注病原微生物,包括肺炎链球菌,金黄色葡萄球菌,肺炎克雷伯菌,铜绿假单胞菌,链球菌A,流感嗜血杆菌,A.鲍曼尼,和大肠杆菌。在细菌培养结果为阴性的情况下,进行核酸提取进行PCR以测定上述八种细菌,以及肺炎支原体和肺炎支原体。此外,尿液标本仅用于检测军团菌抗原。此外,流行病学,人口统计学,临床数据来自电子病历。
结果:该研究涵盖了1266名患者,平均年龄54岁,其中61.6%(780/1266)为男性,61.4%(778/1266)是农民,2020年就医的占88.8%(1124/1266)。此外,80.3%(1017/1266)被安置在普通病房中。最常见的呼吸道症状包括发热(86.8%,1122/1266)和咳嗽(77.8%,986/1266)。在62.6%(792/1266)的病例中发现了胸部影像学异常,58.1%(736/1266)表现出至少一种呼吸道病原体,28.5%(361/1266)有多重感染。此外,95.7%(1212/1266)的患者来自河南省,比例最高(38.3%,486/1266)落在61-80岁年龄段,主要(79.8%,1010/1266)在夏季和秋季寻求医疗援助。细菌检出率(39.0%,495/1266)高于病毒检测率(36.9%,468/1266),主要病原体是流感病毒(13.8%,175/1266),肺炎克雷伯菌(10.0%,127/1266),肺炎链球菌(10.0%,127/1266),腺病毒(8.2%,105/1266),铜绿假单胞菌(8.2%,105/1266),肺炎支原体(7.8%,100/1266),和呼吸道合胞病毒(7.7%,98/1266)。在春季和冬季,流感病毒和人类冠状病毒的流行率很高,与副流感病毒在夏季和秋季的优势形成鲜明对比。呼吸道合胞病毒和鼻病毒在整个春季的患病率较高,夏天,和冬天。铜绿假单胞菌,肺炎克雷伯菌,在所有季节中,肺炎支原体和肺炎支原体的检出率相似,患病率没有明显的峰值。然而,肺炎链球菌表现出独特的模式,在夏季和冬季患病率翻了一番。此外,其他各种病毒和细菌的阳性检出率较低,表现出相对不稳定的流行趋势。在入住重症监护室的患者中,主要的医院细菌是肺炎克雷伯菌(17.2%,43/249),A.鲍曼不动(13.6%,34/249),和铜绿假单胞菌(12.4%,31/249)。相反,普通病房的病人,主要病原体包括流感病毒(14.8%,151/1017),肺炎链球菌(10.4%,106/1017),和腺病毒(9.3%,95/1017)。此外,儿科患者的流感病毒阳性检出率明显较高(23.9%,11/46)和肺炎支原体(32.6%,15/46)与成年人和老年人相比。此外,腺病毒(10.0%,67/669)和鼻病毒(6.4%,43/669)是成人的主要病原体,而肺炎克雷伯菌(11.8%,65/551)和鲍曼不动杆菌(7.1%,39/551)在老年人中盛行,这表明三个年龄组之间存在显著差异。
结论:在华中地区,在SARI患者中,流行的病毒包括流感病毒,腺病毒,和呼吸道合胞病毒.在细菌中,肺炎克雷伯菌,肺炎链球菌,铜绿假单胞菌,肺炎支原体经常被发现,多重感染非常常见。此外,患者中病房和年龄组的病原体谱组成存在很大差异。因此,这项研究有望为政府提供见解,以制定旨在有效预防和管理呼吸道传染病的策略。
BACKGROUND: Severe acute respiratory infection (SARI), a significant global health concern, imposes a substantial disease burden. In China, there is inadequate data concerning the monitoring of respiratory pathogens, particularly bacteria, among patients with SARI. Therefore, this study aims to delineate the demographic, epidemiological, and aetiological characteristics of hospitalised SARI patients in Central China between 2018 and 2020.
METHODS: Eligible patients with SARI admitted to the First Affiliated Hospital of Zhengzhou University between 1 January 2018 and 31 December 2020 were included in this retrospective study. Within the first 24 h of admission, respiratory (including sputum, nasal/throat swabs, bronchoalveolar lavage fluid, thoracocentesis fluid, etc.), urine, and peripheral blood specimens were collected for viral and bacterial testing. A multiplex real-time polymerase chain reaction (PCR) diagnostic approach was used to identify human influenza virus, respiratory syncytial virus, parainfluenza virus, adenovirus, human bocavirus, human coronavirus, human metapneumovirus, and rhinovirus. Bacterial cultures of respiratory specimens were performed with a particular focus on pathogenic microorganisms, including S. pneumoniae, S. aureus, K. pneumoniae, P. aeruginosa, Strep A, H. influenzae, A. baumannii, and E. coli. In cases where bacterial culture results were negative, nucleic acid extraction was performed for PCR to assay for the above-mentioned eight bacteria, as well as L. pneumophila and M. pneumoniae. Additionally, urine specimens were exclusively used to detect Legionella antigens. Furthermore, epidemiological, demographic, and clinical data were obtained from electronic medical records.
RESULTS: The study encompassed 1266 patients, with a mean age of 54 years, among whom 61.6% (780/1266) were males, 61.4% (778/1266) were farmers, and 88.8% (1124/1266) sought medical treatment in 2020. Moreover, 80.3% (1017/1266) were housed in general wards. The most common respiratory symptoms included fever (86.8%, 1122/1266) and cough (77.8%, 986/1266). Chest imaging anomalies were detected in 62.6% (792/1266) of cases, and 58.1% (736/1266) exhibited at least one respiratory pathogen, with 28.5% (361/1266) having multiple infections. Additionally, 95.7% (1212/1266) of the patients were from Henan Province, with the highest proportion (38.3%, 486/1266) falling in the 61-80 years age bracket, predominantly (79.8%, 1010/1266) seeking medical aid in summer and autumn. Bacterial detection rate (39.0%, 495/1266) was higher than viral detection rate (36.9%, 468/1266), with the primary pathogens being influenza virus (13.8%, 175/1266), K. pneumoniae (10.0%, 127/1266), S. pneumoniae (10.0%, 127/1266), adenovirus (8.2%, 105/1266), P. aeruginosa (8.2%, 105/1266), M. pneumoniae (7.8%, 100/1266), and respiratory syncytial virus (7.7%, 98/1266). During spring and winter, there was a significant prevalence of influenza virus and human coronavirus, contrasting with the dominance of parainfluenza viruses in summer and autumn. Respiratory syncytial virus and rhinovirus exhibited higher prevalence across spring, summer, and winter. P. aeruginosa, K. pneumoniae, and M. pneumoniae were identified at similar rates throughout all seasons without distinct spikes in prevalence. However, S. pneumoniae showed a distinctive pattern with a prevalence that doubled during summer and winter. Moreover, the positive detection rates of various other viruses and bacteria were lower, displaying a comparatively erratic prevalence trend. Among patients admitted to the intensive care unit, the predominant nosocomial bacteria were K. pneumoniae (17.2%, 43/249), A. baumannii (13.6%, 34/249), and P. aeruginosa (12.4%, 31/249). Conversely, in patients from general wards, predominant pathogens included influenza virus (14.8%, 151/1017), S. pneumoniae (10.4%, 106/1017), and adenovirus (9.3%, 95/1017). Additionally, paediatric patients exhibited significantly higher positive detection rates for influenza virus (23.9%, 11/46) and M. pneumoniae (32.6%, 15/46) compared to adults and the elderly. Furthermore, adenovirus (10.0%, 67/669) and rhinovirus (6.4%, 43/669) were the primary pathogens in adults, while K. pneumoniae (11.8%, 65/551) and A. baumannii (7.1%, 39/551) prevailed among the elderly, indicating significant differences among the three age groups.
CONCLUSIONS: In Central China, among patients with SARI, the prevailing viruses included influenza virus, adenovirus, and respiratory syncytial virus. Among bacteria, K. pneumoniae, S. pneumoniae, P. aeruginosa, and M. pneumoniae were frequently identified, with multiple infections being very common. Additionally, there were substantial variations in the pathogen spectrum compositions concerning wards and age groups among patients. Consequently, this study holds promise in offering insights to the government for developing strategies aimed at preventing and managing respiratory infectious diseases effectively.