Pneumonia and Electronic Health Records-A Window Into Disease, A Mirror of Our Behavior, or Just Another Streetlight?
Pneumonia and Electronic Health Records-A Window Into Disease, A Mirror of Our Behavior, or Just Another Streetlight?
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肺炎和电子健康记录——了解疾病的窗口、我们行为的镜子，还是只是另一盏路灯？
DOI：
10.1093/cid/ciz1053
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Jones,MakotoMurakami
中科院分区：
文献类型：
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作者：
Jones,BarbaraEllen;Jones,MakotoMurakami
尽管肺炎是美国主要的传染性死亡原因，但它仍然阻碍着我们识别、描述和管理它的努力。因为我们只观察到它的非特定表现，有人可能会说我们从未真正看到过它。然而，人类认识的许多进步来自于对我们用各种方法看不到的现象的巧妙间接观察。我们如何最好地将我们对肺炎的不同观点纳入一个单一的、连贯的理解中？在本期《临床传染病》中，Haessler等人[1]通过来自电子健康记录(EHR)的观察数据的镜头提供了肺炎的重要一瞥。在使用Premier Healthcare数据库(包括微生物学以及管理和临床结果数据)的171 935例肺炎住院患者的大型多中心回顾队列中，他们对比了因肺炎住院的患者的临床特征、治疗模式和结果与血液检测到的病原体和阳性呼吸道培养。他们报告病原体检测的总体流行率非常低：在138 561例培养住院患者中，只有不到10%的患者发现了病原体，其中大多数是通过呼吸道培养确定的。阳性呼吸道培养显示耐药微生物的患病率较高(对甲氧西林耐药
Despite being the leading infectious cause of death in the United States, pneumonia still baffles our attempts to recognize, characterize, and manage it. Because we only observe its nonspecific manifestations, one might say that we never actually see it. However, many advances in human understanding have come from artful indirect observations of phenomena that we cannot see using a variety of methods. How do we best incorporate our different views of pneumonia into a single, coherent understanding? In this issue of Clinical Infectious Diseases, Haessler et al [1] offer an important glimpse of pneumonia through the lens of observational data from the electronic health record (EHR). In a large multicenter retrospective cohort of 171 935 hospitalizations for pneumonia using the Premier Healthcare Database that included microbiology as well as administrative and clinical outcome data, they contrast the clinical characteristics, treatment patterns, and outcomes in patients hospitalized for pneumonia with pathogens detected by blood versus positive respiratory cultures. They report a very low overall prevalence of pathogen detection: less than 10% of 138 561 cultured hospitalizations revealed a pathogen, of which the majority were identified by respiratory culture. Positive respiratory cultures demonstrated a higher prevalence of resistant organisms (methicillin-resistant