Increasing burden of community-acquired pneumonia leading to hospitalisation, 1998-2014.
Increasing burden of community-acquired pneumonia leading to hospitalisation, 1998-2014.
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DOI：
10.1136/thoraxjnl-2015-207688
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发表时间：
2016-06
期刊：
影响因子：
10
通讯作者：
Infections in Oxfordshire Research Database (IORD)
中科院分区：
文献类型：
--
作者：
Quan TP;Fawcett NJ;Wrightson JM;Finney J;Wyllie D;Jeffery K;Jones N;Shine B;Clarke L;Crook D;Walker AS;Peto TE;Infections in Oxfordshire Research Database (IORD)
社区获得性肺炎（CAP）是许多国家死亡率和发病率的主要原因，但最近很少有大规模研究探讨其发病率的趋势。在一个英国地区（牛津郡），使用常规收集的诊断代码计算了在日历时间内导致住院的CAP发生率，并使用分段线性泊松回归进行建模。进一步的模型考虑了其他相关的诊断，典型的行政结果，以及入院时的血液和微生物学检测结果，以确定CAP趋势是否可以通过病例组合，编码实践或入院程序的变化来解释。从1998年到2008年，CAP每年增加4.2%（95% CI 3.6至4.8），随后从2009年到2014年，CAP每年增加8.8%（95% CI 7.8至9.7）。在此期间，与哥伦比亚有关的疾病也大幅增加。住院时间和30天死亡率在以后几年略有下降，但中性粒细胞、尿素和C反应蛋白（CRP）异常的比例没有变化（p>0.2）。CRP严重异常（>100 mg/L）的比例在以后几年略有下降。 所有年龄组的趋势相似。肺炎链球菌是最常见的致病微生物;然而，其他微生物，特别是肠杆菌科，在研究期间的发病率增加（p<0.001）。CAP的住院治疗在牛津郡迅速增加，特别是自2008年以来。几乎没有证据表明这仅仅是由于肺炎编码的变化、人口老龄化或疾病严重程度大大降低的患者更频繁地入院。医疗保健计划，以解决潜在的进一步增加入院和随之而来的抗生素处方应该是一个优先事项。
Community-acquired pneumonia (CAP) is a major cause of mortality and morbidity in many countries but few recent large-scale studies have examined trends in its incidence. Incidence of CAP leading to hospitalisation in one UK region (Oxfordshire) was calculated over calendar time using routinely collected diagnostic codes, and modelled using piecewise-linear Poisson regression. Further models considered other related diagnoses, typical administrative outcomes, and blood and microbiology test results at admission to determine whether CAP trends could be explained by changes in case-mix, coding practices or admission procedures. CAP increased by 4.2%/year (95% CI 3.6 to 4.8) from 1998 to 2008, and subsequently much faster at 8.8%/year (95% CI 7.8 to 9.7) from 2009 to 2014. Pneumonia-related conditions also increased significantly over this period. Length of stay and 30-day mortality decreased slightly in later years, but the proportions with abnormal neutrophils, urea and C reactive protein (CRP) did not change (p>0.2). The proportion with severely abnormal CRP (>100 mg/L) decreased slightly in later years. Trends were similar in all age groups. Streptococcus pneumoniae was the most common causative organism found; however other organisms, particularly Enterobacteriaceae, increased in incidence over the study period (p<0.001). Hospitalisations for CAP have been increasing rapidly in Oxfordshire, particularly since 2008. There is little evidence that this is due only to changes in pneumonia coding, an ageing population or patients with substantially less severe disease being admitted more frequently. Healthcare planning to address potential further increases in admissions and consequent antibiotic prescribing should be a priority.