Can an etiologic agent be identified in adults who are hospitalized for community-acquired pneumonia: results of a one-year study.
Can an etiologic agent be identified in adults who are hospitalized for community-acquired pneumonia: results of a one-year study.
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DOI：
10.1016/j.jinf.2013.03.003
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发表时间：
2013-07
期刊：
影响因子：
--
通讯作者：
Safar H
中科院分区：
文献类型：
--
作者：
Musher DM;Roig IL;Cazares G;Stager CE;Logan N;Safar H
确定社区获得性肺炎（CAP）的原因仍然是个问题。在这项观察性研究中，我们系统地应用目前批准的诊断技术，住院的CAP患者，以确定在其中的病原体可以确定的比例。纳入了所有与CAP结果一致的患者。痰和血培养，肺炎球菌和军团菌抗原，鼻咽拭子病毒PCR，血清降钙素原尿试验，几乎在每一个案例中获得。对入院相关电子病历进行了全面审查。经最终临床诊断，44例患者（17.0%）未感染。仅在60例（23.2%）病例中鉴定出致病菌。PCR检测出呼吸道病毒42例（16.2%），12例合并细菌感染。在119例（45.9%）中，没有发现CAP的原因;其中69例（26.6%）具有与细菌性肺炎难以区分的综合征。降钙素原在细菌感染的患者中升高，而在未感染的患者或病毒感染的患者中较低，但有大量重叠。在259例CAP综合征患者中，只有23.2%的患者有细菌感染的记录，另外26.6%的患者没有确定的细菌病因，但结果与细菌感染非常相似。尽管如此，所有259人都接受了抗菌治疗。仔细观察临床表现可以鉴别出未感染的患者或病毒感染的患者，可能通过降钙素原未升高而得到保证。确定病因诊断仍然是难以捉摸的。我们迫切需要更好的细菌感染鉴别器。
Determining the cause of community-acquired pneumonia (CAP) remains problematic. In this observational study, we systematically applied currently approved diagnostic techniques in patients hospitalized for CAP in order to determine the proportion in which an etiological agent could be identified. All patients admitted with findings consistent with CAP were included. Sputum and blood cultures, urine tests for pneumococcal and Legionella antigens, nasopharyngeal swab for viral PCR, and serum procalcitonin were obtained in nearly every case. Admission-related electronic medical records were reviewed in entirety. By final clinical diagnosis, 44 patients (17.0%) were uninfected. A causative bacterium was identified in only 60 (23.2%) cases. PCR identified a respiratory virus in 42 (16.2%), 12 with documented bacterial coinfection. In 119 (45.9%), no cause for CAP was found; 69 (26.6%) of these had a syndrome indistinguishable from bacterial pneumonia. Procalcitonin was elevated in patients with bacterial infection and low in uninfected patients or those with viral infection, but with substantial overlap. Only 23.2% of 259 patients admitted with a CAP syndrome had documented bacterial infection; another 26.6% had no identified bacterial etiology, but findings closely resembled those of bacterial infection. Nevertheless, all 259 received antibacterial therapy. Careful attention to the clinical picture may identify uninfected patients or those with viral infection, perhaps with reassurance by a non-elevated procalcitonin. Determining an etiologic diagnosis remains elusive. Better discriminators of bacterial infection are sorely needed.
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患有社区获得性肺炎的成年人的呼吸道病毒。
影响因子：
9.6
作者：
Lieberman D;Shimoni A;Shemer-Avni Y;Keren-Naos A;Shtainberg R;Lieberman D
通讯作者：
Lieberman D
影响因子：
--
作者：
Houck, PM;Bratzler, DW;Bartlett, JG
通讯作者：
Bartlett, JG
影响因子：
9.6
作者：
Kanwar, Manreet;Brar, Navkiranjot;Fakih, Mohamad G.
通讯作者：
Fakih, Mohamad G.
影响因子：
11.8
作者：
Albrich, W. C.;Madhi, S. A.;Klugman, K. P.
通讯作者：
Klugman, K. P.
影响因子：
11.8
作者：
Johansson, Niclas;Kalin, Mats;Hedlund, Jonas
通讯作者：
Hedlund, Jonas