Mortality from invasive pneumococcal pneumonia in the era of antibiotic resistance, 1995-1997
Mortality from invasive pneumococcal pneumonia in the era of antibiotic resistance, 1995-1997
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DOI：
10.2105/ajph.90.2.223
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发表时间：
2000-02-01
影响因子：
12.7
通讯作者：
Jorgensen, JH
中科院分区：
文献类型：
--
作者：
Feikin, DR;Schuchat, A;Jorgensen, JH
目标.本研究调查了1995年至1997年影响肺炎球菌肺炎死亡率的流行病学因素。居住在监测区的需要住院治疗的社区获得性肺炎患者和从无菌场所分离出的肺炎链球菌均纳入分析。影响死亡率的因素在单变量和多变量分析中进行了评估。估计了1996年美国因肺炎球菌性肺炎而住院的死亡人数。在5837例病例中，12%是致命的。死亡率增加与年龄较大、基础疾病、亚裔和居住在多伦多/皮尔、安大略有关。当控制这些因素时，死亡率的增加与青霉素或头孢噻肟耐药无关。然而，当排除住院前4天的死亡时，死亡率与青霉素最低抑菌浓度为4.0或更高以及头孢噻肟最低抑菌浓度为2.0或更高显著相关。在2996年，大约7000至12500例死亡发生在美国的肺炎球菌肺炎需要住院治疗。高龄和基础疾病仍然是影响肺炎球菌性肺炎死亡的最重要因素。大多数β-内酰胺耐药肺炎球菌感染的死亡率没有升高。
Objectives. This study examined epidemiologic factors affecting mortality from pneumococcal pneumonia in 1995 through 1997.Methods. Persons residing in a surveillance area who had community-acquired pneumonia requiring hospitalization and Streptococcus pneumoniae isolated from a sterile site were included in the analysis. Factors affecting mortality were evaluated in univariate and multivariate analyses. The number of deaths from pneumococcal pneumonia requiring hospitalization in the United States in 1996 was estimated.Results. Of 5837 cases, 12% were fatal. Increased mortality was associated with older age, underlying disease, Asian race, and residence in Toronto/Peel, Ontario. When these factors were controlled for, increased mortality was not associated with resistance to penicillin or cefotaxime. However, when deaths during the first 4 hospital days were excluded, mortality was significantly associated with penicillin minimum inhibitory concentrations of 4.0 or higher and cefotaxime minimum inhibitory concentrations of 2.0 or higher. In 2996, about 7000 to 12500 deaths occurred in the United States from pneumococcal pneumonia requiring hospitalization.Conclusions. Older age and underlying disease remain the most important factors influencing death from pneumococcal pneumonia. Mortality was not elevated in most infections with beta-lactam-resistant pneumococci.