Etiology of Community-Acquired Pneumonia: Increased Microbiological Yield with New Diagnostic Methods
Etiology of Community-Acquired Pneumonia: Increased Microbiological Yield with New Diagnostic Methods
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DOI：
10.1086/648678
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发表时间：
2010-01-15
影响因子：
11.8
通讯作者：
Hedlund, Jonas
中科院分区：
文献类型：
--
作者：
Johansson, Niclas;Kalin, Mats;Hedlund, Jonas
背景社区获得性肺炎（CAP）的微生物病原学仍然没有得到很好的表征。在过去的几年中，已经开发了用于许多引起呼吸道感染的病原体的基于聚合酶链反应（PCR）的方法。本研究的目的是通过实施一种新的诊断PCR平台结合常规方法来确定成人CAP的病因，特别是CAP患者混合感染的发生。在12个月的时间内，对卡罗林斯卡大学医院收治的成年人进行了前瞻性研究。微生物检测方法包括血液、痰和鼻咽分泌物样本培养;痰样本采用实时定量PCR分析肺炎链球菌、流感嗜血杆菌和卡他莫拉菌;鼻咽样本采用PCR分析;肺炎支原体、肺炎衣原体和呼吸道常见病毒的血清学检测;和尿抗原检测肺炎球菌和嗜肺军团菌抗原。67%的患者（n = 124）可确定微生物病因。对于完整采样的患者，89%的病例确定了微生物病原体。最常见的病原体是S。肺炎（70例患者[38%]）和呼吸道病毒（53例患者[29%]）。在124例确定病因的病例中，43例（35%）存在两种或两种以上病原体。通过用基于PCR的新方法补充传统诊断方法，实现了高微生物产量。这对于完全采样的患者尤其明显。混合感染是常见的（最常见的是S。肺炎与呼吸道病毒）。
Background. The microbial etiology of community-acquired pneumonia ( CAP) is still not well characterized. During the past few years, polymerase chain reaction (PCR)-based methods have been developed for many pathogens causing respiratory tract infections. The aim of this study was to determine the etiology of CAP among adults-especially the occurrence of mixed infections among patients with CAP-by implementing a new diagnostic PCR platform combined with conventional methods.Methods. Adults admitted to Karolinska University Hospital were studied prospectively during a 12-month period. Microbiological testing methods included culture from blood, sputum, and nasopharyngeal secretion samples; sputum samples analyzed by real-time quantitative PCR for Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis; nasopharyngeal specimens analyzed by use of PCR; serological testing for Mycoplasma pneumoniae, Chlamydophila pneumoniae, and viruses common in the respiratory tract; and urine antigen assays for detection of pneumococcal and Legionella pneumophila antigens.Results. A microbial etiology could be identified for 67% of the patients (n = 124). For patients with complete sampling, a microbiological agent was identified for 89% of the cases. The most frequently detected pathogens were S. pneumoniae (70 patients [38%]) and respiratory virus (53 patients [29%]). Two or more pathogens were present in 43 (35%) of 124 cases with a determined etiology.Conclusions. By supplementing traditional diagnostic methods with new PCR-based methods, a high microbial yield was achieved. This was especially evident for patients with complete sampling. Mixed infections were frequent (most commonly S. pneumoniae together with a respiratory virus).