Analysis of clinical characteristics and risk factors of influenza virus complicated with gram-positive bacterial infection in children
10.3760/cma.j.issn.1673-4912.2022.03.008
- VernacularTitle:儿童流感病毒合并革兰阳性菌感染的临床特征及危险因素分析
- Author:
Hui ZHOU
1
;
Yuhui WU
;
Qin YU
;
Jianyu LI
;
Chenglian LI
;
Huabao CHEN
Author Information
1. 中国医科大学深圳市儿童医院儿童重症医学科 518038
- Keywords:
Influenza virus;
Gram-positive bacteria;
Infection;
Children
- From:
Chinese Pediatric Emergency Medicine
2022;29(3):192-198
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the clinical characteristics and risk factors of influenza virus complicated with gram-positive bacterial infection in children.Methods:The clinical data of children with influenza virus complicated with gram-positive bacterial infection hospitalized at Shenzhen Children′s Hospital affiliated to China Medical University from January 2013 to December 2019 (observation group) were retrospectively studied.During the same period, 110 hospitalized children with influenza virus infection without co-infection were selected as the control group.The clinical data of the children in two groups were analyzed.Logistic regression analysis was used to analyze the risk factors of influenza virus complicated with gram-positive bacterial infection.Results:There were 108 children in the observation group, including 68 boys and 40 girls, with the age of(2.6±1.8)years, and 100(92.6%) children under 5 years old.Incidence month distribution: 61 cases from January to March, 15 cases from April to June, 13 cases from July to September, and 19 cases from October to December.In the observation group, 73 cases were infected with influenza A virus, 35 cases were infected with influenza B virus, 94(87.0%)cases were complicated with Streptococcus pneumoniae infection, 11 cases with Group A Streptococcus infection and 8 cases with Staphylococcus aureus infection.And 15 (13.9%) cases had underlying diseases.None of the patients in the observation group received pneumococcal conjugate vaccine, and two cases received influenza vaccine within one year.There were 110 children in the control group, including 57 boys and 53 girls, with the age of (5.0±2.4)years old.There were 80 cases of influenza A virus infection and 30 cases of influenza B virus infection.Four cases had underlying diseases, six cases received 13-valent pneumococcal conjugate vaccine and 12 cases received influenza vaccine within one year.Compared with the control group, the children in the observation group were younger[(2.6±1.8)years vs.(5.0±2.4) years, χ2=-7.935, P<0.001], had more underlying diseases[13.9%(15/108)vs.3.6%(4/110), χ2=7.200, P=0.007], less proportion of influenza vaccine[1.9%(2/108)vs.10.9%(12/110), χ2=7.439, P=0.006], the hospitalization time was longer[6(5, 7)d vs.4(3, 5)d, Z=-7.278, P<0.001], and mone cases of first use of neuraminidase inhibitors(NAI) for more than 48 hours[75.9%(82/108)vs.14.5%(16/110), χ2=82.971, P<0.001]. In the observation group, there were 97 culture-positive specimens of Streptococcus pneumoniae, including 89 of sputum/bronchoalveolar lavage fluid, five of blood culture and three of cerebrospinal fluid.All Streptococcus pneumoniae were resistant to erythromycin and clindamycin; the resistance rates of non-meningitis Streptococcus pneumoniae to ceftriaxone, cefotaxime and penicillin were 7.7%, 5.5% and 1.1%, respectively, and all the strains were sensitive to vancomycin, linezolid and levofloxacin.All patients in the observation group were treated with NAI and antibiotics, 37 cases were treated with bronchoalveolar lavage, 27 cases were admitted to pediatric intensive care unit, 10 cases were treated by non-invasive continuous positive airway pressure ventilation, and 17 cases received mechanical ventilation; 6 cases died.Logistic regression analysis showed that underlying diseases, unvaccinated with influenza and (or) pneumococcal vaccine, and the first use of NAI>48 hours were risk factors for influenza virus complicated with gram-positive bacterial infection. Conclusion:Influenza virus complicated with gram-positive bacterial infection can aggravate the illness and even death of children.Early identification of gram-positive bacterial infection, timely treatment of NAI and antibiotics, and active control of complications could be helpful to improve the cure rate.Strengthening influenza and pneumococcal vaccine during flu season can help reduce infection.
