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[Lancet Infect Dis在线发表]:新西兰军团菌病的疾病负担研究
2019年07月12日 时讯速递, 进展交流 暂无评论

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The burden of Legionnaires' disease in New Zealand (LegiNZ): a national surveillance study

Patricia C Priest, Sandy Slow, Stephen T Chambers, et al

Lancet Published:June 10, 2019 DOI:https://doi.org/10.1016/S1473-3099(19)30113-6

Summary

Background 背景

Legionnaires' disease is under-diagnosed because of inconsistent use of diagnostic tests and uncertainty about whom to test. We assessed the increase in case detection following large-scale introduction of routine PCR testing of respiratory specimens in New Zealand.

由于诊断方法应用缺乏一致性,以及待检测人群的不确定性,军团菌病的诊断不足。在新西兰大规模引入对呼吸道标本的常规PCR检测后,我们对军团菌病病例检出增加的情况进行了评估。

Methods 方法

LegiNZ was a national surveillance study done over 1-year in which active case-finding was used to maximise the identification of cases of Legionnaires' disease in hospitals. Respiratory specimens from patients of any age with pneumonia, who could provide an eligible lower respiratory specimen, admitted to one of 20 participating hospitals, covering a catchment area of 96% of New Zealand's population, were routinely tested for legionella by PCR. Additional cases of Legionnaires' disease in hospital were identified through mandatory notification.

LegiNZ是一项全国性调查,在为期1年的时间内采用主动检测病例的方法以最大限度检出医院内军团菌病的病例。参加研究的20家医院(服务区域覆盖了新西兰96%的人口)所收治的任何年龄肺炎患者,只要能够得到合格的下呼吸道标本,都常规进行军团菌PCR检测。通过强制报告系统发现医院内其他军团菌病病例。

Findings 结果

Between May 21, 2015, and May 20, 2016, 5622 eligible specimens from 4862 patients were tested by PCR. From these, 197 cases of Legionnaires' disease were detected. An additional 41 cases were identified from notification data, giving 238 cases requiring hospitalisation. The overall incidence of Legionnaires' disease cases in hospital in the study area was 5·4 per 100 000 people per year, and Legionella longbeachae was the predominant cause, found in 150 (63%) of 238 cases.

在2015年5月21日至2016年5月20日间,共有来自4862名患者的5622份合格标本进行了PCR检测。其中检出197例军团菌病病例。此外,从报告数据中发现了另外41例病例,共计238例患者需要住院接受治疗。在研究区域中,医院内军团菌病的总发病率为每100000人每年5.4例,其中以长滩军团菌最为常见,占238例患者中的150例(63%)。

Interpretation 结论

The rate of notified disease during the study period was three-times the average over the preceding 3 years. Active case-finding through systematic PCR testing better clarified the regional epidemiology of Legionnaires' disease and uncovered an otherwise hidden burden of disease. These data inform local Legionnaires' disease testing strategies, allow targeted antibiotic therapy, and help identify outbreaks and effective prevention strategies. The same approach might have similar benefits if applied elsewhere in the world.

研究期间发现的病例相当于此前3年内平均水平的3倍。通过系统性PCR检测主动发现病例能够更好地了解本地军团菌病的流行病学情况,揭示不为人知的疾病负担。这些资料有助于了解本地军团菌病检测策略,促进针对性抗生素治疗,帮助确定暴发流行并制定有效预防策略。相同的方法应用于世界其他地区可能有相似的益处。

Funding

Health Research Council of New Zealand.

评论[仅代表个人观点]

  • 非典型病原体是社区获得性肺炎的重要致病微生物
  • 重症社区获得性肺炎的经验性抗生素必须覆盖非典型病原体

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