Community-acquired pneumonia in chronic obstructive pulmonary disease - A Spanish multicenter study
Community-acquired pneumonia in chronic obstructive pulmonary disease - A Spanish multicenter study
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DOI：
10.1164/ajrccm.154.5.8912764
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发表时间：
1996-11-01
影响因子：
24.7
通讯作者：
Serra, J
中科院分区：
文献类型：
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作者：
Torres, A;Dorca, J;Serra, J
社区获得性肺炎(CAP)是一种传染性疾病，当存在并存条件时，经常会促使患者入院治疗。然而，CAP与患者潜在疾病的流行病学关系并不是很清楚。我们进行了一项前瞻性的多中心研究，目的是评估慢性阻塞性肺疾病(COPD)合并CAP患者的临床特征、病因和预后。1992年10月至1994年12月，我们研究了124例COPD患者(平均FEV(1)40+/-11%，平均FVC/FEV(1)49+/-10)。通过血培养(n=123)、痰培养(n=97)、胸腔积液培养(n=17)、标本刷检(n=41)、经皮胸针抽吸(n=41)和血清学(n=106)等方法进行病因诊断。80例(%)获得了病因诊断，而基于有效技术的诊断只有73例(59%)是可能的。主要致病菌依次为肺炎链球菌32株(43%)、肺炎衣原体9株(12%)、流感嗜血杆菌7株(9%)、嗜肺军团菌7株(9%)、绿色链球菌3株(4%)、伯氏柯克斯体3株(4%)、肺炎支原体2株(3%)、类固醇诺卡氏菌2株、SSP曲霉2株。1例，其余10例。其中3例为多菌感染。菌血症19例(15%)，肺炎链球菌最常见(13例)。22例因病原学发现而修改抗生素治疗，9例因治疗失败而修改抗生素治疗。10例死亡(8%)，22例需要机械通气，后者的死亡率为23%。32株肺炎链球菌对青霉素完全或部分耐药10株(31%)，红霉素耐药2株(6%)。本研究结果对COPD合并肺炎患者经验性抗生素策略的标准化具有重要意义。
Community-acquired pneumonia (CAP) is an infectious illness that frequently motivates hospital admission when comorbid conditions are present. However, the epidemiology of CAP in relation to the underlying disease of the patients is not well known. We performed a prospective multicenter study with the aim of assessing the clinical characteristics, etiology, and outcome of chronic obstructive pulmonary disease (COPD) patients with CAP. Between October 1992 and December 1994 we studied 124 COPD patients (mean FEV(1) 40 +/- 11% of predicted, mean FVC/FEV(1) 49 +/- 10) admitted because of CAP to one of the participating centers. An attempt to obtain an etiologic diagnosis was performed by means of blood cultures (n = 123), sputum cultures (n = 97), pleural fluid cultures (n = 17), protected specimen brush samples (n = 41), percutaneous transthoracic needle aspiration (n = 41), and serology (n = 106). Etiologic diagnosis was achieved in 80 (64%) of cases, however, diagnosis based upon valid techniques was only possible in 73 (59%) cases. The main causal microorganisms were the following: Streptococcus pneumoniae in 32 (43%), Chlamydia pneumoniae in 9 (12%), Hemophilus influenzae in 7 (9%), Legionella pneumophila in 7 (9%), Streptococcus viridans in 3 (4%), Coxiello burnetii in 3 (4%), Mycoplasma pneumoniae in 2 (3%), Nocardia osteroides 2, Aspergillus ssp. 1, and others 10. In three of these cases the etiology was polymicrobial. Bacteremia was present in 19 (15%) cases; S. pneumoniae was the most frequent isolate (13 cases). Antibiotic treatment was modified in 22 cases due to etiologic findings, and in 9 due to therapeutic failure. Ten patients died (8%), and 22 needed mechanical ventilation, the mortality rate in the latter population being 23%. Total or partial resistance of S. pneumoniae to penicillin was observed in 10 of 32 (31%) isolations, and to erythromycin in 2 (6%). The results of this study are Important for the standardization of empiric antibiotic strategies in COPD patients with pneumonia.