A及B型流感合併細菌感染之回溯性研究

Retrospective study on Type A and B influenza with bacterial co-infection

黃昭偉(Chiu-Wai Wong)

指導教授 ： 周明智講座教授

中山醫學大學/醫學院/醫學研究所/碩士(2013年)

https://doi.org/10.6834/CSMU.2013.00100

摘要

背景:
回溯A，B型流感合併細菌感染病例。描述其流行病學，進而討論臨床病程，發病機制及臨床處理等問題。

材料及方法:
本研究是回溯分析台灣中部某醫學中心，從2011年1月至2012年3月間，共1702流感疑似病例進行咽喉拭子檢測流感個案。本研究經資料蒐集完成之後，去除孕婦病患7名，共有750名患者被納入。患者分為兩組，所有年齡組別和18歲以下組別。病患以抽取血液樣本作白血球計數，C反應球蛋白及細菌培養。所有病患有接受胸部X光檢查，確認肺炎症狀。統計以費雪精確性檢定類變項目包括性別、A/B型流感、陽性培養結果及死亡率。利用曼－惠特尼U考驗法檢定年齡及住院天數。

結果:
A型流感個案共336例， B型流感共414例。其中23例細菌培養陽性。最常見的細菌為肺炎鏈球菌（39.1％）及金黃色葡萄球菌（30.4％），尤其是在18歲以下組別。合併細菌感染之流感病患之住院時間顯著較高。A型流感合併細菌感染以肺炎鏈球菌為主，感染後易得肺炎。B型流感合併細菌感染以金黃色葡萄球菌為主。本研究中一位B型流感合併金黃色葡萄球菌死亡。研究中，白血球計數，C反應球蛋白對流感嚴重度並無關聯性。

結論:
繼發細菌感染仍是小童及老年人常見且潛在致命的併發症。建立經驗性治療，及早以抗生素合併抗病毒劑可顯著改善繼發細菌感染患者的預後。流感及肺炎連球菌疫苗接種率高，也提高高風險患者的預防能力。最後，希望醫界對流感合併細菌性感染能提高警覺性。

關鍵字

A及B型流行性感冒 ； 合併性細菌性感染

並列摘要

Background:
To review the presentation of type A and B influenza with bacterial co-infection in medical center and describe the epidemiology of co-infection. We also discuss the clinical course, pathogenesis, and rational clinical management of co-infection.

Material and method:
We retrospectively analyzed the medical records of 1702 influenza-like patients who underwent nasopharyngeal swab, from January 2011 to March 2012, at the medical center of Chung Shan Medical University Hospital. Totally 750 patients were included in this study. Patients were divided into two groups, all age group and under 18 years group.

Results:
336 cases with influenza type A, 414 cases with influenza type B infection. There are 23 reports presented positive bacterial culture. The most common bacterial organisms causing co-infections were Streptococcus Pneumoniae (39.1%), and Staphylococcus aureus (30.4%), especially in under 18 years group. The length of hospitalization stay was higher in positive culture with pneumonia.

Conclusion:
Secondary bacterial infection following influenza remains a common and potentially deadly complication for older adults. Therapeutic options are shrinking with the emergence of antibiotic resistance in community-acquired respiratory pathogens, particularly Streptococcus pneumoniae. Empiric therapy with anti-virus agents may significantly improve prognosis. Higher rates of influenza vaccination would also improve our ability to protest these at-risk patients.

並列關鍵字

Type A and B influenza ； bacterial co-infection

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