Microbial aetiology of community-acquired pneumonia and its relation to severity
Microbial aetiology of community-acquired pneumonia and its relation to severity
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DOI：
10.1136/thx.2010.143982
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发表时间：
2011-04-01
期刊：
影响因子：
10
通讯作者：
Torres, Antoni
中科院分区：
文献类型：
--
作者：
Cilloniz, Catia;Ewig, Santiago;Torres, Antoni
研究社区获得性肺炎（CAP）的微生物病原学分布和病死率与临床环境和严重程度评分（肺炎严重程度指数（PSI）和混淆度、血尿素氮、呼吸频率、血压、年龄（CURB-65））的关系。方法纳入3523例CAP患者（门诊15%，住院85%）。分析微生物病原学分布与临床环境和严重程度评分（PSI, CURB-65）的关系，以及不同病原学在严重程度评分中的相对死亡率。结果确定病因1463例（42%），死亡257例（7%）。病因的排名因护理地点而异，住院患者和icu患者中肺炎链球菌和混合病因的频率增加，非典型病原体的频率下降。病因按严重程度评分分布有相应的规律；然而，严重程度评分对革兰氏阴性肠杆菌（GNEB）和铜绿假单胞菌更敏感，而对中度和高风险疾病的混合病因识别不太敏感。根据病因和严重程度评分的死亡率显示，除非典型病原体外，所有病原体的死亡率都在增加。肺炎链球菌的死亡率最高，而GNEB、铜绿假单胞菌、金黄色葡萄球菌和混合病因的死亡率最高。根据护理部位和预后评分，嗜肺军团菌的分布相似。结论非典型细菌性病原体引起的CAP在临床和严重程度评分中都被认为是低风险的疾病。严重程度评分在鉴别GNEB和铜绿假单胞菌为中度和高风险病因方面更为敏感，而混合病因可能被低估。
Background The distribution of the microbial aetiology and mortality of community-acquired pneumonia (CAP) was investigated in relation to the clinical setting and severity scores (pneumonia severity index (PSI) and confusion, blood urea nitrogen, respiratory rate, blood pressure, age (CURB-65)).Methods 3523 patients with CAP were included (15% outpatients, 85% inpatients). The distribution of the microbial aetiology in relation to the clinical setting and severity scores (PSI, CURB-65) and the relative mortality of different aetiologies across the severity scores were analysed.Results The aetiology was established in 1463 patients (42%), of whom 257 died (7%). The ranking of aetiologies varied according to site of care, with increasing frequency of Streptococcus pneumoniae and mixed aetiologies and decreasing frequency of atypical pathogens in hospitalised patients and those in ICUs. The distribution of aetiologies according to severity scores showed corresponding patterns; however, the severity scores were more sensitive to Gram-negative enteric bacilli (GNEB) and Pseudomonas aeruginosa and less sensitive in identifying mixed aetiologies as moderate- and high-risk conditions. Mortality rates according to aetiology and severity scoring showed increasing mortality rates for all pathogens except atypical pathogens. S pneumoniae had the highest number of deaths while GNEB, P aeruginosa, Staphylococcus aureus and mixed aetiologies had the highest mortality rates. Legionella pneumophila was similarly distributed according to site of care and prognostic scores.Conclusions CAP due to atypical bacterial pathogens is recognised both clinically and by severity scoring as a low-risk condition. Severity scores are more sensitive in identifying patients with GNEB and P aeruginosa as moderate- and high-risk aetiologies whereas mixed aetiologies may be underestimated.