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美国成人患社区获得性肺炎住院治疗现状
Community-Acquired Pneumonia Requiring Hospitalization among U.S. Adults


Seema Jain ... 呼吸系统疾病 • 2015.07.30
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• 哪种预后工具能最准确地预测社区获得性肺炎患者死亡率 • 更多证据表明,类固醇可使社区获得性肺炎患者获益 • 成人社区获得性肺炎的抗生素治疗方案

摘要


背景

造成美国成人住院治疗及死亡的感染性疾病中,社区获得性肺炎是一主要原因。我们需要使用经放射学影像及其他现有的实验室诊断试验确诊的社区获得性肺炎,来估计其发病率。

 

方法

我们在芝加哥和纳什维尔(Nashville)的5家医院开展了一项主动的、基于人群的、针对成人(年龄≥18岁)社区获得性肺炎且需要住院治疗的患者的调查。近期有住院史或严重免疫抑制状态的患者被排除。我们统一收集了患者的血液、尿液、呼吸道相关标本以进行培养、血清学检查、抗原检测、分子诊断试验。放射科医师独立进行胸片的阅片。我们计算了需住院治疗的社区获得性肺炎基于人群的发病率,并把发病率按年龄和病原体细分。

 

结果

从2010年1月至2012年6月,从3,634例符合条件的成人患者中总共纳入2,488例患者(68%)。在2,320例有放射学证据的肺炎患者(93%)中,中位年龄为57岁(四分位数,46~71岁);498例(21%)患者需要重症监护,有52例(2%)患者死亡。在2,259例同时有放射学证据的肺炎和可进行细菌以及病毒检测的呼吸道标本的患者中,在853例(38%)患者可检测到病原体:检测到一种或一种以上病毒的有530例(23%),检出细菌的有247例(11%),同时有细菌和病毒病原体的有59例(3%),有真菌或分枝杆菌病原体的有17例(1%)。最常见的病原体为人类鼻病毒(9%的患者中)、流感病毒(6%)、肺炎链球菌(5%)。肺炎年发病率为24.8/10,000成人(95%置信区间,23.5~26.1),其中年龄在65~79岁的患者(63.0/10,000成人)、年龄≥80岁的患者(164.3/10,000成人)发病率最高。对于每一类病原体,其发病率随着年龄增加而增加。

 

结论

需住院治疗的社区获得性肺炎在老年人中发病率最高。尽管应用当前的诊断试验,大部分患者仍无法检测出病原体。呼吸道病毒的检出比细菌更为常见(该研究由美国国家免疫和呼吸系统疾病中心流感部[Influenza Division of the National Center for Immunizations and Respiratory Diseases]赞助)。





作者信息

Seema Jain, M.D., Wesley H. Self, M.D., M.P.H., Richard G. Wunderink, M.D., Sherene Fakhran, M.D., M.P.H., Robert Balk, M.D., Anna M. Bramley, M.P.H., Carrie Reed, Ph.D., Carlos G. Grijalva, M.D., M.P.H., Evan J. Anderson, M.D., D. Mark Courtney, M.D., James D. Chappell, M.D., Ph.D., Chao Qi, Ph.D., Eric M. Hart, M.D., Frank Carroll, M.D., Christopher Trabue, M.D., Helen K. Donnelly, R.N., B.S.N., Derek J. Williams, M.D., M.P.H., Yuwei Zhu, M.D., Sandra R. Arnold, M.D., Krow Ampofo, M.D., Grant W. Waterer, M.B., B.S., Ph.D., Min Levine, Ph.D., Stephen Lindstrom, Ph.D., Jonas M. Winchell, Ph.D., Jacqueline M. Katz, Ph.D., Dean Erdman, Dr.P.H., Eileen Schneider, M.D., M.P.H., Lauri A. Hicks, D.O., Jonathan A. McCullers, M.D., Andrew T. Pavia, M.D., Kathryn M. Edwards, M.D., and Lyn Finelli, Dr.P.H., for the CDC EPIC Study Team*
From the Centers for Disease Control and Prevention, Atlanta (S.J., A.M.B., C.R., M.L., S.L., J.M.W., J.M.K., D.E., E.S., L.A.H., L.F.); Vanderbilt University School of Medicine (W.H.S., C.G.G., J.D.C., F.C., D.J.W., Y.Z., K.M.E.) and University of Tennessee Health Science Center–Saint Thomas Health (C.T.), Nashville, and Le Bonheur Children’s Hospital (S.R.A., J.A.M.), University of Tennessee Health Science Center (S.R.A., J.A.M.), and St. Jude Children’s Research Hospital (J.A.M.), Memphis — all in Tennessee; Northwestern University Feinberg School of Medicine (R.G.W., E.J.A., D.M.C., C.Q., E.M.H., H.K.D., G.W.W.), John H. Stroger, Jr., Hospital of Cook County (S.F.), and Rush University Medical Center (R.B.) — all in Chicago; University of Utah Health Sciences Center, Salt Lake City (K.A., A.T.P.); and University of Western Australia, Perth (G.W.W.).Address reprint requests to Dr. Jain at the Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, MS A-32, Atlanta, GA 30333, or at bwc8@cdc.gov. *A complete list of members of the Centers for Disease Control and Prevention (CDC) Etiology of Pneumonia in the Community (EPIC) Study Team is provided in the Supplementary Appendix, available at NEJM.org.

 

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