Community-acquired pneumonia in Southeast Asia - The microbial differences between ambulatory and hospitalized patients
Community-acquired pneumonia in Southeast Asia - The microbial differences between ambulatory and hospitalized patients
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DOI：
10.1378/chest.123.5.1512
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发表时间：
2003-05-01
期刊：
影响因子：
9.6
通讯作者：
Chanthadisai, N
中科院分区：
文献类型：
--
作者：
Wattanathum, A;Chaoprasong, C;Chanthadisai, N
研究目的：确定在东南亚引起社区获得性肺炎（CAP）的微生物病原体。设计：一项前瞻性研究。设定：泰国三家综合医院。患者：245例成人患者，从1998年9月至2001年4月符合CAP临床标准。干预措施：检查包括痰革兰氏染色和培养、血培养、胸水培养（如果存在），嗜肺军团菌和肺炎链球菌的尿抗原，肺炎支原体、肺炎衣原体和嗜肺军团菌的血清学。结果：研究纳入了98名门诊患者和147名住院患者，98例门诊病人中74例（75.5%）和147例住院病人中105例（71.4%）检出病原体。肺炎衣原体（36.7%）、肺炎支原体（29.6%）和肺炎链球菌（13.3%）是门诊患者最常见的病原体，而肺炎链球菌（22.4%）和肺炎衣原体（16.3%）是住院患者最常见的病原体。在门诊患者中，肺炎衣原体（分别为36.7%和16.3%; p < 0.001）和肺炎支原体（分别为29.6%和6.8%; p < 0.001）的发病率显著高于住院患者。肺炎链球菌、嗜肺军团菌和混合感染的发生率在两组之间没有差异。混合感染的98例门诊病人（13.3%）和9 147例住院患者（6.1%），与肺炎衣原体是最常见的合并感染的病原体。结论：数据表明，在东南亚引起CAP的核心微生物是没有什么不同，在西方国家。因此，CAP患者的治疗指南应该相同。
Study objectives: To determine microbial agents causing community-acquired pneumonia (CAP) in Southeast Asia.Design: A prospective study. Setting: Three general hospitals in Thailand.Patients: Two hundred forty-five adult patients fulfilling the clinical criteria of CAP from September 1998 to April 2001. Interventions: Investigations included sputum Gram stain and culture, blood culture, pleural fluid culture (if presented), urine antigen for Legionella pneumophila and Streptococcus pneumoniae, and serology for Mycoplasma pneumoniae, Chlamydia pneumoniae, and L pneumophila.Results: There were 98 outpatients and 147 hospitalized patients included in the study, and an organism was identified in 74 of 98 outpatients (75.5%) and 105 of 147 of the hospitalized patients (71.4%). C pneumoniae (36.7%), M pneumoniae (29.6%), and S pneumoniae (13.3%) were the most frequent causative pathogens found in outpatients, while S pneumoniae (22.4%) and C pneumoniae (16.3%) were the most common in hospitalized patients. There was a significantly higher incidence of C pneumoniae (36.7% vs 16.3%, respectively; p < 0.001) and M pneumoniae (29.6% vs 6.8%; p < 0.001, respectively) in the outpatients than in the hospitalized patients. The incidence of S pneumoniae, L pneumophila, and mixed infections was not different between the groups. Mixed infections were presented in 13 of 98 outpatients (13.3%) and 9 of 147 hospitalized patients (6.1%), with C pneumoniae being the most frequent coinfecting pathogen.Conclusions: The data indicate that the core organisms causing CAP in Southeast Asia are not different from those in the Western countries. The guidelines for the treatment of patients with CAP, therefore, should be the same.