COVID-19 期间社区获得性肺炎的临床特征和分离出的微生物

Meritxell Gavalda, Maria Isabel Fullana, Adrià Ferre, Rebecca Rowena Peña, Julen Armendariz, Orla Torrallardona, Aina Magraner, Alejandro Lorenzo, Carles García, Gemma Mut, Lluís Planas, Carla Iglesias, Pablo Fraile-Ribot, Maria Dolores Macia Romero, Melchor Riera, Mercedes García-Gasalla
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摘要

导言。社区获得性肺炎是导致死亡和住院的主要原因。有 30-65% 的病例病因不明。分子检测可用于多种病原体检测,目前正在研究如何改进病因诊断。研究方法我们开展了一项前瞻性研究,以描述 COVID-19 大流行期间社区获得性肺炎的临床特征和病原学,并评估微生物检验的诊断效果,包括呼吸道病原体分子检验(FilmArray™ 生物梅里埃)。结果。自 2021 年 2 月 1 日至 2022 年 3 月 31 日,共纳入 225 名患者。约 70% 的患者微生物鉴定失败。肺炎链球菌是最常见的分离菌。病毒性肺炎有 5 例。经测试的 FilmArray 阳性率较低,仅为 7%,主要用于诊断病毒合并感染。结论。尽管我们制定了广泛的诊断方案,但微生物鉴定率仍然很低。我们观察到,在 COVID-19 大流行期间,流感和其他病毒性肺炎病例有所减少。到达急诊科时 NEWS2 分数较高、患有活动性血液病或慢性神经系统疾病以及微生物检测结果呈阳性都与较差的预后有关。要确定分子检测在肺炎微生物学诊断中的作用,还需要进一步的研究。
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Clinical Characteristics and Microorganisms Isolated in Community-Acquired Pneumonia in the COVID-19 Period
Introduction. Community-acquired pneumonia is a leading cause of mortality and hospital admissions. The aetiology remains unknown in 30–65% of the cases. Molecular tests are available for multiple pathogen detection and are under research to improve the causal diagnosis. Methods. We carried out a prospective study to describe the clinical characteristics and aetiology of community-acquired pneumonia during the COVID-19 pandemic and to assess the diagnostic effectivity of the microbiological tests, including a molecular test of respiratory pathogens (FilmArray™ bioMérieux). Results. From the 1st of February 2021 until the 31st of March 2022, 225 patients were included. Failure in microorganism identification occurred in approximately 70% of patients. Streptococcus pneumoniae was the most common isolate. There were 5 cases of viral pneumonia. The tested FilmArray exhibited a low positivity rate of 7% and mainly aided in the diagnosis of viral coinfections. Conclusions. Despite our extensive diagnostic protocol, there is still a low rate of microorganism identification. We have observed a reduction in influenza and other viral pneumoniae during the COVID-19 pandemic. Having a high NEWS2 score on arrival at the emergency department, an active oncohematological disease or chronic neurological conditions and a positive microbiological test result were related to worse outcomes. Further research is needed to determine the role of molecular tests in the microbiological diagnosis of pneumonia.
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