Characteristics and risk factors for outcomes in patients with Mycoplasma pneumoniae mono- and coinfections: A multicenter surveillance study in Wuhan, China, 2023

IF 8.8 3区 医学 Q1 Medicine
Banghua Chen , Jie Pan , Ying Peng , Yuanyuan Zhang , Yunan Wan , Hongjie Wei , Kangguo Li , Wentao Song , Yunkang Zhao , Kang Fang , Huiming Ye , Jiali Cao , Jia Rui , Zeyu Zhao , Tianmu Chen
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Abstract

Objectives

Mycoplasma pneumoniae (MP) is a key cause of community-acquired pneumonia, and coinfections lead to varied patient outcomes. A comprehensive understanding of the outcome characteristics and associated etiologies of coinfections in MP patients is lacking.

Methods and results

We analyzed 121,357 MP cases from 522,292,680 visits in Wuhan, China, in 2023 (the final year of the COVID-19 pandemic). Children aged 1–10 years had the highest incidence, whereas those over 60 years had elevated hospitalization, severe infection, and fatality rates. Coinfection patterns differed by age, with bacterial-viral-Chlamydia pneumoniae (C. pneumoniae) / other pathogens prevalent in infants, bacterial-viral pathogens prevalent in preschoolers, and viral-viral pathogens prevalent in school-aged children. Bacterial coinfections were most common in MP-infected patients, especially those who were hospitalized. Coinfection, especially with C. pneumoniae, Pseudomonas aeruginosa (P. aeruginosa), Haemophilus influenzae (H. influenzae), and Streptococcus pneumoniae (S. pneumoniae), increased hospitalization rates. The most severe outcomes and deaths occurred in patients coinfected with C. pneumoniae-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), influenza A-parainfluenza virus (PIV) or adenovirus-PIV. Logistic regression analysis demonstrated that male sex and adult age (particularly ≥40 years) were significantly associated with adverse outcomes in MP monoinfection. For coinfections, significantly higher hospitalization rates were reported among very young children (0–5 years) and adults aged ≥40 years, whereas adults presented an increased risk of severe disease. Coinfection outcomes were significantly associated with seasons of the year (winter, spring, and summer), specific age groups (3–5 years, 18–39 years, 40–50 years, and 60 years and over), gender (male), and longer onset-to-diagnosis periods. Middle-aged and elderly patients, coinfection, spring and summer, gender (male), and longer onset-to-diagnosis periods were significantly associated with increased hospitalization and serious illness risk. Coinfection, winter, older (adult) age, and gender (male) were significantly associated with an increased risk of death.

Conclusions

Compared with adults, children with MP have a greater morbidity risk, whereas middle-aged and older adults face greater risks of hospitalization, serious illness, and death. Coinfection with other pathogens heightens hospitalization and death risks. These insights are crucial for etiological screening, diagnosing multiple pathogens, and preventing and treating infections.
肺炎支原体单一和合并感染患者预后的特征和危险因素:2023年中国武汉的一项多中心监测研究
目的肺炎支原体(mycoplasma pneumoniae, MP)是社区获得性肺炎的主要病因,合并感染可导致不同的患者预后。缺乏对MP患者合并感染的结局特征和相关病因的全面了解。方法和结果我们分析了2023年(COVID-19大流行的最后一年)中国武汉市522292680例就诊的121357例MP病例。1-10岁的儿童发病率最高,而60岁以上的儿童住院率、严重感染率和死亡率都较高。共感染模式因年龄而异,婴儿中普遍存在细菌-病毒-肺炎衣原体/其他病原体,学龄前儿童中普遍存在细菌-病毒病原体,学龄儿童中普遍存在病毒-病毒病原体。细菌共感染在mp感染患者中最为常见,尤其是住院患者。合并感染,特别是与肺炎假单胞菌、铜绿假单胞菌、流感嗜血杆菌和肺炎链球菌的合并感染,增加了住院率。最严重的结果和死亡发生在合并感染肺炎c -严重急性呼吸综合征冠状病毒2 (SARS-CoV-2)、甲型副流感病毒(PIV)或腺病毒-PIV的患者中。Logistic回归分析显示,男性性别和成年年龄(尤其是≥40岁)与单MP感染的不良结局显著相关。对于合并感染,据报道,非常年幼的儿童(0-5岁)和≥40岁的成年人的住院率明显较高,而成年人出现严重疾病的风险增加。合并感染结局与季节(冬季、春季和夏季)、特定年龄组(3-5岁、18-39岁、40-50岁和60岁及以上)、性别(男性)和较长的发病至诊断期显著相关。中老年患者、合并感染、春夏季、性别(男性)、发病至诊断期较长与住院率和重症风险增加显著相关。合并感染、冬季、年龄较大(成人)和性别(男性)与死亡风险增加显著相关。结论与成人相比,儿童MP的发病风险更高,而中老年MP的住院、重症和死亡风险更高。与其他病原体合并感染会增加住院和死亡风险。这些见解对于病原学筛查、诊断多种病原体以及预防和治疗感染至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Infectious Disease Modelling
Infectious Disease Modelling Mathematics-Applied Mathematics
CiteScore
17.00
自引率
3.40%
发文量
73
审稿时长
17 weeks
期刊介绍: Infectious Disease Modelling is an open access journal that undergoes peer-review. Its main objective is to facilitate research that combines mathematical modelling, retrieval and analysis of infection disease data, and public health decision support. The journal actively encourages original research that improves this interface, as well as review articles that highlight innovative methodologies relevant to data collection, informatics, and policy making in the field of public health.
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