[Lancet最新论文]:南亚儿童社区获得性严重感染的病因及发病率 | 中国病理生理学会危重病医学专业委员会
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[Lancet最新论文]:南亚儿童社区获得性严重感染的病因及发病率
2018年07月25日 时讯速递, 进展交流 暂无评论

Causes and incidence of community-acquired serious infections among young children in south Asia (ANISA): an observational cohort study

Samir K Saha, Stephanie J Schrag, Shams El Arifeen, et al.

Lancet 2018; 392: 145-159

Summary
Background 背景

More than 500 000 neonatal deaths per year result from possible serious bacterial infections (pSBIs), but the causes are largely unknown. We investigated the incidence of community-acquired infections caused by specific organisms among neonates in south Asia.

每年超过500000新生儿死于可能的严重细菌性感染(pSBIs),但病因却不清楚。我们研究了南亚新生儿社区获得性感染的病因及其发病率。

Methods 方法

From 2011 to 2014, we identified babies through population-based pregnancy surveillance at five sites in Bangladesh, India, and Pakistan. Babies were visited at home by community health workers up to ten times from age 0 to 59 days. Illness meeting the WHO definition of pSBI and randomly selected healthy babies were referred to study physicians. The primary objective was to estimate proportions of specific infectious causes by blood culture and Custom TaqMan Array Cards molecular assay (Thermo Fisher, Bartlesville, OK, USA) of blood and respiratory samples.

从2011年至2014年,我们在缅甸、印度和巴基斯坦的5个中心通过基于人口的妊娠监测确定新生儿。社区卫生工作者在这些新生儿出生后0-59天内进行不超过10次的家访。由研究医生对满足WHO有关pSBI定义的患儿及随机选择的健康儿童进行诊治。主要目的在于通过血培养及血液和呼吸道标本的Custom TaqMan Array Cards分子分析确定的特殊感染病因的比例。

Findings 结果

6022 pSBI episodes were identified among 63 114 babies (95·4 per 1000 livebirths). Causes were attributed in 28% of episodes (16% bacterial and 12% viral). Mean incidence of bacterial infections was 13·2 (95% credible interval [CrI] 11·2–15·6) per 1000 livebirths and of viral infections was 10·1 (9·4–11·6) per 1000 livebirths. The leading pathogen was respiratory syncytial virus (5·4, 95% CrI 4·8–6·3 episodes per 1000 livebirths), followed by Ureaplasma spp (2·4, 1·6–3·2 episodes per 1000 livebirths). Among babies who died, causes were attributed to 46% of pSBI episodes, among which 92% were bacterial. 85 (83%) of 102 blood culture isolates were susceptible to penicillin, ampicillin, gentamicin, or a combination of these drugs.

在63114名新生儿中确定了6022次pSBI(每1000名活产新生儿95·4次)。大约28%的感染可确定病因(16%为细菌性,12%为病毒性)。细菌感染的平均发病率为每1000名活产新生儿 13·2 次(95%可信区间 [CrI] 11·2–15·6),病毒感染平均发病率为每 1000名活产新生儿 10·1 次 (9·4–11·6)。最常见的致病微生物为呼吸道合胞病毒(每1000名活产新生儿5·4次,95% CrI 4·8–6·3),其次为脲原体属(每1000名活产新生儿2·4次,1·6–3·2)。

Interpretation 结论

Non-attribution of a cause in a high proportion of patients suggests that a substantial proportion of pSBI episodes might not have been due to infection. The predominance of bacterial causes among babies who died, however, indicates that appropriate prevention measures and management could substantially affect neonatal mortality. Susceptibility of bacterial isolates to first-line antibiotics emphasises the need for prudent and limited use of newer-generation antibiotics. Furthermore, the predominance of atypical bacteria we found and high incidence of respiratory syncytial virus indicated that changes in management strategies for treatment and prevention are needed. Given the burden of disease, prevention of respiratory syncytial virus would have a notable effect on the overall health system and achievement of Sustainable Development Goal.

很高病例的患儿无法确定病因,提示很多pSBI可能并非感染引起。然而,死亡婴儿中细菌为主,提示适当的预防及诊治措施可能显著影响新生儿病死率。细菌对一线抗生素保持敏感,强调了需要谨慎并限制使用新一代抗生素。另外,我们发现非典型细菌及呼吸道合胞病毒发生率较高,提示相关治疗及预防策略需要进行改变。鉴于上述疾病负担,预防呼吸道合胞病毒感染可能对整个卫生系统及可持续发展目标造成显著影响。

Funding 资助

Bill & Melinda Gates Foundation

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