Community-Acquired Pneumonia Requiring Hospitalization among U.S. Adults.
Community-Acquired Pneumonia Requiring Hospitalization among U.S. Adults.
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DOI：
10.1056/nejmoa1500245
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发表时间：
2015-07-30
期刊：
影响因子：
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通讯作者：
CDC EPIC Study Team
中科院分区：
文献类型：
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作者：
Jain S;Self WH;Wunderink RG;Fakhran S;Balk R;Bramley AM;Reed C;Grijalva CG;Anderson EJ;Courtney DM;Chappell JD;Qi C;Hart EM;Carroll F;Trabue C;Donnelly HK;Williams DJ;Zhu Y;Arnold SR;Ampofo K;Waterer GW;Levine M;Lindstrom S;Winchell JM;Katz JM;Erdman D;Schneider E;Hicks LA;McCullers JA;Pavia AT;Edwards KM;Finelli L;CDC EPIC Study Team
社区获得性肺炎是美国成年人住院和死亡的主要传染性原因。需要对经放射学证实的肺炎的发病率进行估计，并使用当前的实验室诊断试验。我们在芝加哥和纳什维尔的五家医院对18岁或以上需要住院治疗的社区获得性肺炎进行了基于人群的积极监测。排除近期住院或严重免疫抑制的患者。系统收集血液、尿液和呼吸道标本进行培养、血清学检测、抗原检测和分子诊断检测。研究放射科医生独立审查胸片。我们根据年龄和病原体计算了需要住院治疗的社区获得性肺炎的人群发病率。从2010年1月到2012年6月，我们招募了3634名合格成人中的2488名（68%）。在2320例有肺炎影像学证据的成人（93%）中，患者的中位年龄为57岁（四分位距，46 - 71岁）; 498例患者（21%）需要重症监护，52例（2%）死亡。在2259例有肺炎X线影像学证据和可用于细菌和病毒检测的标本的患者中，853例（38%）检测到病原体：530例（23%）检测到一种或多种病毒，247例（11%）检测到细菌，59例（3%）检测到细菌和病毒病原体，17例（1%）检测到真菌或分枝杆菌病原体。最常见的病原体是人鼻病毒（9%的患者）、流感病毒（6%）和肺炎链球菌（5%）。肺炎的年发病率为每10，000名成人24.8例（95%置信区间，23.5至26.1），其中65至79岁（每10，000名成人63.0例）和80岁或以上（每10，000名成人164.3例）的成人发病率最高。对于每种病原体，发病率随着年龄的增长而增加。需要住院治疗的社区获得性肺炎的发病率在老年人中最高。尽管目前的诊断测试，在大多数患者中没有检测到病原体。呼吸道病毒的检出率高于细菌。（由国家免疫和呼吸系统疾病中心流感部门资助。
Community-acquired pneumonia is a leading infectious cause of hospitalization and death among U.S. adults. Incidence estimates of pneumonia confirmed radio-graphically and with the use of current laboratory diagnostic tests are needed. We conducted active population-based surveillance for community-acquired pneumonia requiring hospitalization among adults 18 years of age or older in five hospitals in Chicago and Nashville. Patients with recent hospitalization or severe immunosuppression were excluded. Blood, urine, and respiratory specimens were systematically collected for culture, serologic testing, antigen detection, and molecular diagnostic testing. Study radiologists independently reviewed chest radiographs. We calculated population-based incidence rates of community-acquired pneumonia requiring hospitalization according to age and pathogen. From January 2010 through June 2012, we enrolled 2488 of 3634 eligible adults (68%). Among 2320 adults with radiographic evidence of pneumonia (93%), the median age of the patients was 57 years (interquartile range, 46 to 71); 498 patients (21%) required intensive care, and 52 (2%) died. Among 2259 patients who had radio-graphic evidence of pneumonia and specimens available for both bacterial and viral testing, a pathogen was detected in 853 (38%): one or more viruses in 530 (23%), bacteria in 247 (11%), bacterial and viral pathogens in 59 (3%), and a fungal or mycobacterial pathogen in 17 (1%). The most common pathogens were human rhinovirus (in 9% of patients), influenza virus (in 6%), and Streptococcus pneumoniae (in 5%). The annual incidence of pneumonia was 24.8 cases (95% confidence interval, 23.5 to 26.1) per 10,000 adults, with the highest rates among adults 65 to 79 years of age (63.0 cases per 10,000 adults) and those 80 years of age or older (164.3 cases per 10,000 adults). For each pathogen, the incidence increased with age. The incidence of community-acquired pneumonia requiring hospitalization was highest among the oldest adults. Despite current diagnostic tests, no pathogen was detected in the majority of patients. Respiratory viruses were detected more frequently than bacteria. (Funded by the Influenza Division of the National Center for Immunizations and Respiratory Diseases.)