The Incidence and Etiology of Influenza-Associated Community-Acquired Pneumonia i

描述（由申请人提供）：肺炎仍然是美国发病率和死亡率的主要感染性原因。尽管美国有巨大的公共卫生负担，但最近对美国肺炎发病率的测量却出奇地少，而且研究方法的差异使得对现有估计的比较存在问题。此外，我们目前对社区获得性肺炎（CAP）病原微生物分布的了解有限，并且主要基于几十年前或国外进行的病例系列或研究。新的分子技术的可用性为系统地重新评估这些知识提供了机会。如果目前没有大规模的基于人群的研究来告知临床医生肺炎最可能的病因和耐药菌的鉴定，临床医生将继续像过去几十年那样评估和治疗肺炎患者。自2010年1月以来，我们通过cdc资助的研究“住院患者流感相关肺炎的发病率和病因学”，对所有年龄的受试者进行了积极的基于人群的肺炎监测。纳入和检测符合条件的肺炎患者的程序已得到很好的确立；已编制和测试了数据收集表格；建立了疾病预防控制中心认可的实验室程序；目前正在收集大量数据并有系统地输入主项目数据库；每个肺炎病例的x光片正在由研究放射科医生进行评估。有了这些完善的研究方法和经验，我们完全有能力将cdc资助的肺炎项目再延长两年。我们建议利用我们现有的基础设施、技术人员、网络能力和以往的经验来开展一项多中心、基于人群的前瞻性队列研究，以确定导致儿童和成人住院的肺炎的发病率和病因。我们的项目包括以下具体目标：1)确定居住在田纳西州中部的儿童和成人因社区获得性肺炎住院的发生率；2)确定不同呼吸道病原体对中田纳西州住院儿童和成人社区获得性肺炎病因学的相对贡献；3)确定田纳西州中部住院儿童和成人与社区获得性肺炎相关的流感负担。

DESCRIPTION (provided by applicant): Pneumonia remains the leading infectious cause of morbidity and mortality in the United States. In spite of its substantial public health burden, recent measurements of pneumonia incidence in the United States are surprisingly scarce and differences in research methodologies make the comparison of available estimates problematic. Moreover, our current knowledge of the distribution of etiologic organisms for community-acquired pneumonia (CAP) is limited and largely based on case series or studies performed decades ago or abroad. The availability of novel molecular techniques provides opportunities to reassess this knowledge systematically. Without current large-scale population-based studies to inform clinicians about the most likely etiologies of pneumonia and the identification of resistant organisms, clinicians would continue to assess and treat patients with pneumonia as they have for the past several decades. Since January 2010 we have conducted active population-based surveillance for pneumonia in subjects of all ages through the CDC-funded study, "The incidence and etiology of influenza-associated pneumonia in hospitalized persons." The procedures for enrolling and testing eligible pneumonia patients have been well established; data collection forms have been developed and tested; CDC-endorsed laboratory procedures have been established; extensive data are now being collected and systematically entered into the master project databases; and radiographs from each pneumonia case are being evaluated by study radiologists. With these well established study methodologies and experience, we are well positioned to continue the CDC-funded pneumonia project for two additional years. We propose to use our existing infrastructure, skilled personnel, network capabilities, and previous experience to perform a multicenter, population-based, prospective cohort study to determine the incidence and etiologies of pneumonia leading to hospitalization for both children and adults. Our project encompasses the following specific aims: 1)To determine the incidence of hospitalization for community- acquired pneumonia in children and adults living in Middle Tennessee; 2) To determine the relative contributions of the different respiratory pathogens to the etiology of community-acquired pneumonia in children and adults hospitalized in Middle Tennessee; and, 3)To establish the burden of influenza associated with community-acquired pneumonia in children and adults hospitalized in Middle Tennessee.