Estimating the burden of pneumococcal pneumonia among adults: a systematic review and meta-analysis of diagnostic techniques.
Estimating the burden of pneumococcal pneumonia among adults: a systematic review and meta-analysis of diagnostic techniques.
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DOI：
10.1371/journal.pone.0060273
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发表时间：
2013
期刊：
影响因子：
3.7
通讯作者：
Watt JP
中科院分区：
文献类型：
--
作者：
Said MA;Johnson HL;Nonyane BA;Deloria-Knoll M;O'Brien KL;AGEDD Adult Pneumococcal Burden Study Team;Andreo F;Beovic B;Blanco S;Boersma WG;Boulware DR;Butler JC;Carratalà J;Chang FY;Charles PG;Diaz AA;Domínguez J;Ehara N;Endeman H;Falcó V;Falguera M;Fukushima K;Garcia-Vidal C;Genne D;Guchev IA;Gutierrez F;Hernes SS;Hoepelman AI;Hohenthal U;Johansson N;Kolek V;Kozlov RS;Lauderdale TL;Mareković I;Masiá M;Matta MA;Miró Ò;Murdoch DR;Nuermberger E;Paolini R;Perelló R;Snijders D;Plečko V;Sordé R;Strålin K;van der Eerden MM;Vila-Corcoles A;Watt JP
肺炎球菌性肺炎在成人中引起显著的发病率和死亡率。鉴于非菌血症性肺炎球菌性肺炎诊断检测的局限性，大多数研究报告了菌血症或侵袭性肺炎球菌性疾病（IPD）的发病率，因此严重低估了肺炎球菌性肺炎的负担。我们的目的是制定一个概念和定量的策略，以估计非菌血症疾病的负担在成人社区获得性肺炎（CAP）使用系统的研究方法和尿抗原检测的可用性。我们对研究进行了系统的文献综述，提供了各种诊断检测（BinaxNOW® S.肺炎球菌性肺炎的尿抗原检测（UAT）与血液和/或痰培养）在诊断肺炎球菌性肺炎中的应用。我们使用随机效应荟萃分析方法和自举法估计了菌血症性肺炎球菌性肺炎的比例、肺炎球菌引起的CAP的比例以及Binax UAT在传统诊断技术之外的额外贡献。我们在分析中纳入了35项研究，主要来自发达国家。菌血症肺炎球菌性肺炎的估计比例为24.8%（95% CI：21.3%，28.9%）。肺炎球菌引起CAP的比例估计为27.3%（95%CI：23.9%，31.1%）。Binax UAT诊断出的CAP比传统技术多11.4%（95% CI：9.6，13.6%）。我们的局限性在于，并非所有患者都接受了所有的诊断测试，以及诊断测试本身的敏感性和特异性。我们解决了这些偏差，并提供了一系列合理的值，以估计成人肺炎球菌肺炎的负担。仅从菌血症性肺炎球菌肺炎数据估计成人肺炎球菌疾病负担明显低估了成人疾病的真实负担。对于每一例菌血症性肺炎球菌肺炎，我们估计至少有3例非菌血症性肺炎球菌肺炎。
Pneumococcal pneumonia causes significant morbidity and mortality among adults. Given limitations of diagnostic tests for non-bacteremic pneumococcal pneumonia, most studies report the incidence of bacteremic or invasive pneumococcal disease (IPD), and thus, grossly underestimate the pneumococcal pneumonia burden. We aimed to develop a conceptual and quantitative strategy to estimate the non-bacteremic disease burden among adults with community-acquired pneumonia (CAP) using systematic study methods and the availability of a urine antigen assay. We performed a systematic literature review of studies providing information on the relative yield of various diagnostic assays (BinaxNOW® S. pneumoniae urine antigen test (UAT) with blood and/or sputum culture) in diagnosing pneumococcal pneumonia. We estimated the proportion of pneumococcal pneumonia that is bacteremic, the proportion of CAP attributable to pneumococcus, and the additional contribution of the Binax UAT beyond conventional diagnostic techniques, using random effects meta-analytic methods and bootstrapping. We included 35 studies in the analysis, predominantly from developed countries. The estimated proportion of pneumococcal pneumonia that is bacteremic was 24.8% (95% CI: 21.3%, 28.9%). The estimated proportion of CAP attributable to pneumococcus was 27.3% (95% CI: 23.9%, 31.1%). The Binax UAT diagnosed an additional 11.4% (95% CI: 9.6, 13.6%) of CAP beyond conventional techniques. We were limited by the fact that not all patients underwent all diagnostic tests and by the sensitivity and specificity of the diagnostic tests themselves. We address these resulting biases and provide a range of plausible values in order to estimate the burden of pneumococcal pneumonia among adults. Estimating the adult burden of pneumococcal disease from bacteremic pneumococcal pneumonia data alone significantly underestimates the true burden of disease in adults. For every case of bacteremic pneumococcal pneumonia, we estimate that there are at least 3 additional cases of non-bacteremic pneumococcal pneumonia.
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DOI：
10.1016/s0140-6736(03)15021-0
发表时间：
2003-12-13
期刊：
Lancet (London, England)
影响因子：
--
作者：
File TM
通讯作者：
File TM
DOI：
10.1007/s10096-003-0997-0
发表时间：
2003-10-01
影响因子：
4.5
作者：
Beovic, B;Bonac, B;Letonja, S
通讯作者：
Letonja, S
影响因子：
3
作者：
Ehara, Naomi;Fukushima, Kiyoyasu;Kohn, Shigeru
通讯作者：
Kohn, Shigeru
影响因子：
39.2
作者：
AUSTRIAN, R;GOLD, J
通讯作者：
GOLD, J
DOI：
10.1016/0197-2456(86)90046-2
发表时间：
1986-09-01
期刊：
CONTROLLED CLINICAL TRIALS
影响因子：
--
作者：
DERSIMONIAN, R;LAIRD, N
通讯作者：
LAIRD, N