Pulmonary tuberculosis and bacterial pneumonia co-infection: a clinical etiology investigation in China
LI Xiao-ying1,DUAN Hong-fei2,YANG Li-mei3,LIU Xiao-qing4,HUANG Yan-feng1,LI Wei-min5
1.Department of Infections and Gastroenterology, Children's Hospital Affiliated to Chongqing Medical University, Chongqing 400014, China; 2.Department of Medicine, Beijing Tuberculosis and Thoracic Tumor Research Institute/ Beijing Chest Hospital, Capital Medical University, Beijing 101149, China; 3.Laboratory Department, Beijing Tuberculosis and Thoracic Tumor Research Institute/ Beijing Chest Hospital, Capital Medical University, Beijing 101149, China; 4.Department of Infectious Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100730, China; 5.National Tuberculosis Clinical Laboratory of China, Beijing Tuberculosis and Thoracic Tumor Research Institute / Beijing Chest Hospital, Capital Medical University, Beijing 101149, China
Abstract:Pulmonary tuberculosis with bacterial pneumonia co-infection represents an additional treatment challenge over tuberculosis alone. However, little information is available on this co-infection in China. We performed a retrospective investigation of all pulmonary tuberculosis and bacterial pneumonia co-infection cases at the National Tuberculosis Clinical Center of China (Beijing Chest Hospital) from June 2009 to June 2012. We calculated the odds ratios (OR) and performed multivariate logistic regression analysis to identify the risk factors associated with co-infection. M. tuberculosis and pathogenic bacteria co-infection were identified and tested for drug resistance using standard methods. The spectra of pathogenic bacteria isolated from pneumonia and tuberculosis co-infection were distinctive. The most predominant pathogen was Pseudomonas aeruginosa (25%, 66/268). Pulmonary cavities (adjusted OR=0.57, 95% CI: 0.43-0.75, P=0.000), female (adjusted OR=0.61, 95% CI: 0.45-0.82, P=0.000) and the age of 40-59 (adjusted OR=1.79, 95% CI: 1.30-2.26, P=0.000) were significantly correlated with the co-infection. Two strains of methicillin-resistant S. aureus(MRSA), 5 strains of pan-drug-resistant P. aeruginosa, and 2 strains of pan-drug-resistant Acinetobacter baumannii were isolated from the culture-positive tuberculosis patients. Our findings highlight the need to develop and implement investigations of tuberculosis and bacterial pneumonia co-infection as well as the need to comprehensively treat the co-infection and routinely monitor drug-resistant cases.
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