广西成人社区获得性肺炎889例病原学多中心调查

目的为掌握广西地区成人社区获得性肺炎(CAP)的病原学构成情况,比较广西农村和城市CAP的病原学构成特点,推进广西地区CAP的规范化诊疗。方法收集2008-01~2010-12广西14所县市级医院的889例CAP患者,进行病原学调查,并根据地域分为城市地区(城市组331例)和农村地区(农村组578例),比较病原学构成比差异。结果研究期CAP病例中阳性422例患者入选,共检出486株病原菌,前五位的病原菌为肺炎支原体(138/486,28.40%)、流感嗜血杆菌(88/486,18.11%)、肺炎链球菌(77/486,15.84%)、肺炎克雷伯杆菌(53/486,10.91%)和肺炎衣原体(43/486,8.94%)。农村组肺炎支原体、铜绿假单胞菌感染的CAP比例高于城市组(41.12%vs 19.72%和5.58%vs 1.73%),而肺炎链球菌、嗜肺军团菌感染低于城市组(8.1%vs 21.11%和3.05%vs 7.96%)。城市组细菌(除外嗜肺军团菌)多见(183例,占63.3%),农村组则以非典型病原体多见(104例,占52.8%)。结论广西成人CAP病原学以肺炎支原体最常见,流感嗜血杆菌和肺炎链球菌也是常见菌群。广西农村地区以非典型病原菌为主,城市则以细菌常见。     

老年社区获得性肺炎住院患者临床资料分析

目的总结老年社区获得性肺炎（CAP）患者的临床表现、病原学及预后相关资料。方法回顾分析2002年1月~2007年10月我院收治的CAP患者的临床资料,比较老年CAP患者（年龄）≥60岁）与中青年患者（年龄≤60岁）临床特征的异同。结果成人CAP患者321例,年龄（67±22）岁。老年CAP患者231例,其中73.4%患者合并基础疾病,住院死亡率为12%,肺炎链球菌仍是老年CAP患者的最主要致病菌。与90例中青年CAP患者相比,老年CAP患者入院时出现呼吸困难、急性意识障碍、心率增快及呼吸急促的比例明显增多,病原体分布与中青年CAP患者存在差异。结论老年CAP患者发病率高、并发症多、预后差。临床表现、病原学具有其特殊性,应予足够重视。     

社区老年获得性肺炎30例临床分析

目的通过30例老年社区获得性肺炎（CAP）患者的病原学特征、临床表现、基础疾病及并发症情况,以期为临床治疗提供帮助。方法分析30例老年CAP患者的病原学特征、基础疾病及并发症情况。结果老年CAP患者的痰菌培养的阳性率比较高,以革兰氏阴性杆菌为主。有76.67%（23/30）老年CAP患者伴有基础病。其中66.67%（20/30）患者伴有2～3种基础病。临床表现：（1）发病比较缓慢;（2）患病表征不明显,没有典型症状。结论临床医生应对老年CAP进行及时诊断,避免抗生素的滥用,减少并发症的发生,从而提高老年CAP的治愈率,减少老年CAP的病死率。     

社区获得性肺炎住院患者病原体构成分析

目的了解近四年来唐山地区成人社区获得性肺炎住院患者病原谱构成。方法收集在河北联合大学附属医院呼吸内科住院治疗的400例成人社区获得性肺炎患者资料,分析其病原谱构成。1400例成人CAP住院治疗患者中,病原体阳性患者为245人,病原体检出率为61．3％。细菌培养阳性。结果细菌感染患者140人,细菌检出率为35％,其中革兰氏阳性细菌占29．9％,革兰氏阴性细菌占70．1％,最常见致病菌为肺炎克雷伯杆菌（9．8％）、肺炎链球菌（6．5％）、铜绿假单胞菌（4．5％）。血清学检测非典型病原体IgM抗体阳性患者50人,检出率为（12．5％）,病毒抗体阳性患者55人,检出率（13．8％）。结论唐山地区成人CAP患者最常见的感染类型为细菌感染、其后依次非典型性病原体感染、病毒感染,其中细菌感染以革兰氏阴性细菌为主。     

老年社区获得性肺炎住院患者的临床资料分析

目的总结老年社区获得性肺炎（CAP）患者的临床表现、病原学及预后相关资料。方法回顾性分析2002年1月-2006年1月中山大学附属第三医院收治的成人CAP患者的临床资料,比较老年CAP患者（年龄〉65岁）与中青年CAP患者（年龄≤65岁）临床特征的异同。结果成人CAP患者302例,年龄（68±21）岁。老年CAP患者216例,其中67．1％的患者合并基础疾病,175例（81．0％）患者在Fine危险分级Ⅳ～Ⅴ级,住院病死率为12．0％。肺炎链球菌仍是老年CAP患者最主要的致病菌。与86例中青年CAP患者相比,老年CAP患者入院时出现呼吸困难、急性意识障碍、心率增快及呼吸急促的比例明显增多,病原体分布与中青年CAP患者存在差异。结论老年CAP患者发病率高、并发症多、预后差。临床表现、病原学具有其特殊性,应予足够重视。     

急诊卫生保健相关性肺炎的临床分析

目的探讨我院急诊科卫生保健相关性肺炎(health care associated pneumonia,HCAP)的临床特点。方法回顾性分析研究自2013年1月至2014年9月我院急诊科就诊的肺炎患者临床资料,并从发病年龄、合并基础疾病、痰培养结果、需呼吸机支持、住院天数及预后,与社区获得性肺炎(CAP)相比较。结果入组HCAP患者68例,CAP患者82例,HCAP患者合并基础疾病65例(95.6%),明显高于CAP 32例(39%);HCAP痰培养阳性率48.3%,其中革兰氏阴性菌占64.3%,与CAP(23.1%)比较有显著统计学意义(P0.01);HCAP患者住院天数、需呼吸机支持患者、死亡率均高于CAP患者,具有统计学意义。结论 HCAP是与CAP不同的肺炎类型,多为老年患者,合并症多,致病菌以革兰氏阴性菌为主,存在细菌耐药性高,预后差的临床特点。     

冬季社区获得性肺炎的病原菌及耐药性分析

目的：了解2013年冬季该院社区获得性肺炎（ community acquired pneumonia ,CAP）住院患者中致病菌的构成比、常见致病菌的耐药情况,为CAP的诊断及经验治疗提供依据。方法回顾性分析2013－10-2014－03该院收治所有确诊为CAP患者108例的临床资料及病原学检查资料。结果108例患者送检痰标本128例,检出致病菌64株,检出率为50．0％,肺炎克雷伯杆菌、白色念珠菌为前两位菌种。肺炎克雷伯杆菌对碳青霉烯类、第三代头孢菌素、喹诺酮类药物敏感性较高,对第一代、二代头孢菌素及大环内酯类药物耐药性较高。结论冬季获得性肺炎致病菌以革兰阴性菌为主,最常见为肺炎克雷伯杆菌。对于老年患者,合并慢性阻塞性肺疾病、支气管扩张等基础病的患者应重视抗革兰阴性菌治疗。     

老年社区获得性肺炎183例临床分析

目的调查住院的老年社区获得性肺炎（CAP）临床资料。方法我院住院老年263例CAP患者资料。结果263例中,男性150例,女性113例。大于60岁者183例（占69．6％）,非老年组80例（占30．4％）,老年CAP住院人数显著高于非老年组。老年组中基础疾病多于非老年组。老年组病原菌以革兰氏阴性杆菌为主。结论老年人CAP特点是基础疾病多、临床不典型、联合应用抗生素,同时加强营养支持可降低病死率。     

骨科老年住院患者死亡情况分析

目的分析骨科老年住院患者的死亡情况。方法对北京军区总医院骨科2011年1月至2015年12月期间老年住院患者死亡病例进行回顾性分析,包括患者一般情况、入院诊断、合并内科疾病及死亡原因等。结果共收集54例死亡患者,男性26例,女性28例,平均年龄82.3岁。57.4%的死亡患者因髋部骨折入院。合并内科疾病最常见的为高血压,占44.4%。同时患有≥3种疾病的患者占48.1%。肺部感染是死亡最常见的原因,占70.3%。结论骨科老年住院死亡患者中以髋部骨折最常见,多数患者通常合并多种内科疾病,肺部感染是死亡的主要原因。     

病毒及非典型病原体致社区获得性肺炎住院患者的临床分析

目的使用快速检测方法对呼吸科住院社区获得性肺炎(CAP)患者进行病毒及非典型病原体感染检测,了解其感染状况。方法对2013年2月至2015年2月北京解放军306医院呼吸科收治的301例CAP住院患者应用胶体金免疫层析法(GICA)检测流感病毒A、B(FluA、B),呼吸道合胞病毒(RSV),腺病毒(ADV)及嗜肺军团菌(LP)抗原,并使用快速培养法检测有无肺炎支原体(MP)感染,对住院CAP患者呼吸道病毒抗原和不典型病原体检出率进行分析统计。结果呼吸道病毒及非典型病原体检测总阳性检出率为55.5%,老年患者(≥65岁)FluA/B检出率均显著高于65岁以下患者(P0.05);MP培养的阳性率与LP抗原阳性的检出率,65岁以上组均显著低于65岁以下组(P0.05)。春、冬季FluA抗原的阳性检出率均高于夏、秋季(P0.05);冬季支原体培养阳性检出率明显高于夏、秋季(P0.05)。没有基础病的患者的FluA抗原的检出率明显低于合并基础病患者(P0.05)。结论呼吸道病毒和不典型病原体是住院CAP患者的重要病原,季节、年龄及是否合并基础疾病是感染风险重要影响因素。     

Community-acquired pneumonia in the elderly.

The incidence of community-acquired pneumonia (CAP) in the elderly is higher compared to younger populations. In addition, pneumonia in the elderly is a life-threatening problem. As our demographics have changed, clinicians have developed a heightened interest in managing pneumonia in the elderly. The development of pneumonia in elderly patients differs from that in younger individuals due to a complex array of factors. (1) The organisms involved depend on the setting in which the pneumonia developed: either the nonhospitalized elderly patient with CAP or the institutionalized patient who develops nursing-home-acquired pneumonia. (2) Underlying comorbid conditions commonly exist in the elderly that affect the etiology and outcome of pneumonia. Overall, Streptococcus pneumoniae and Haemophilus influenzae are still the most common etiologies of pneumonia in the elderly. The true role of gram-negative bacilli remains unclear although these micro-organisms may be more common etiologic agents in nursing-home pneumonia. Some recent studies from Mediterranean areas have reported high rates of infection by Chlamydia pneumoniae, but the real role of this micro-organism has to be confirmed. Another important issue is that the presenting symptoms of pneumonia in the elderly can be subtle and sometimes difficult to recognize. Fever is frequently absent, and delirium or alteration of functional physical capacity may be the only manifestations. Mortality in the elderly with CAP is higher when compared to younger populations. However, this may be explained by the concomitant presence of comorbid conditions more than by age per se. This statement has to be kept in mind when considering hospital and, particularly, intensive care unit admissions. Finally, antibiotic pharmacokinetics in the elderly populations with CAP ought to be considered to avoid frequent side-effects and complications. Overall, antibiotic regimens in hospitalized elderly patients with CAP do not differ from other hospitalized CAP populations. An organized approach to assessing elderly patients with suspicion of pneumonia and an awareness of common pitfalls in the management of this pulmonary infection in this population are essential to improving outcomes.     

无反应性社区获得性肺炎的临床分析

目的分析无反应性社区获得性肺炎(CAP)的病原学及病因诊断。方法分析我院40例无反应性CAP,其中A组12例伴COPD等基础病,B组28例无基础病。按CAP指南治疗无效,后完善检查,明确诊断。结果 A组8例曲霉菌、3例结核;1例病原菌不详,在万古霉素联合头孢哌酮-舒巴坦治疗后好转。B组中,致病菌明确的耐药菌共10例,结核杆菌、曲霉菌各2例,非感染性疾病5例,肺炎链球菌合并结核菌1例;病原菌不详、在万古霉素联合头孢哌酮-舒巴坦治疗后好转8例。结论对伴基础病的无反应性CAP,以曲霉菌、结核菌感染常见,不伴基础病者,以耐药阳性球菌或阴性杆菌为主。     

Etiology of community-acquired pneumonia in a population-based study: Link between etiology and patients characteristics, process-of-care, clinical evolution and outcomes

ABSTRACT: BACKGROUND: The etiologic profile of community-acquired pneumonia (CAP) for each age group could be similar among inpatients and outpatients. This fact brings up the link between etiology of CAP and its clinical evolution and outcome. Furthermore, the majority of pneumonia etiologic studies are based on hospitalized patients, whereas there have been no recent population-based studies encompassing both inpatients and outpatients. METHODS: To evaluate the etiology of CAP, and the relationship among the different pathogens of CAP to patients characteristics, process-of-care, clinical evolution and outcomes, a prospective population-based study was conducted in Spain from April 1, 2006, to June 30, 2007. Patients (age >18) with CAP were identified through the family physicians and the hospital area. RESULTS: A total of 700 patients with etiologic evaluation were included: 276 hospitalized and 424 ambulatory patients. We were able to define the aetiology of pneumonia in 55.7% (390/700). The most frequently isolated organism was S. pneumoniae (170/390, 43.6%), followed by C. burnetti (72/390, 18.5%), M. pneumoniae (62/390, 15.9%), virus as a group (56/390, 14.4%), Chlamydia species (39/390, 106%), and L. pneumophila (17/390, 4.4%). The atypical pathogens and the S. pneumoniae are present in pneumonias of a wide spectrum of severity and age. Patients infected by conventional bacteria were elderly, had a greater hospitalization rate, and higher mortality within 30 days. CONCLUSIONS: Our study provides information about the etiology of CAP in the general population. The microbiology of CAP remains stable: infections by conventional bacteria result in higher severity, and the S. pneumoniae remains the most important pathogen. However, atypical pathogens could also infect patients in a wide spectrum of severity and age.     

Etiology of community-acquired pneumonia in hospitalized patients in chile: the increasing prevalence of respiratory viruses among classic pathogens

BACKGROUND AND STUDY OBJECTIVES: The range and relative impact of microbial pathogens, particularly viral pathogens, as a cause of community-acquired pneumonia (CAP) in hospitalized adults has not received much attention. The aim of this study was to determine the microbial etiology of CAP in adults and to identify the risk factors for various specific pathogens. METHODS: We prospectively studied 176 patients (mean [+/- SD] age, 65.8 +/- 18.5 years) who had hospitalized for CAP to identify the microbial etiology. For each patient, sputum and blood cultures were obtained as well as serology testing for Mycoplasma pneumoniae and Chlamydophila pneumoniae, urinary antigen testing for Legionella pneumophila and Streptococcus pneumoniae, and a nasopharyngeal swab for seven respiratory viruses. RESULTS: Microbial etiology was determined in 98 patients (55%). S pneumoniae (49 of 98 patients; 50%) and respiratory viruses (32%) were the most frequently isolated pathogen groups. Pneumococcal pneumonia was associated with tobacco smoking of > 10 pack-years (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.2 to 5.4; p = 0.01). Respiratory viruses were isolated more often in fall or winter (28%; p = 0.011), and as an exclusive etiology tended to be isolated in patients >/= 65 years of age (20%; p = 0.07). Viral CAP was associated with antimicrobial therapy prior to hospital admission (OR, 4.5; 95% CI, 1.4 to 14.6). CONCLUSIONS: S pneumoniae remains the most frequent pathogen in adults with CAP and should be covered with empirical antimicrobial treatment. Viruses were the second most common etiologic agent and should be tested for, especially in fall or winter, both in young and elderly patients who are hospitalized with CAP.     

老年人社区获得性肺炎病原学的调查

目的探讨老年人社区获得性肺炎（CAP）发病相关的主要因素及病原学特点。方法对151例老年人CAP住院患者,总结其基础疾病及其病原学分布特点。结果老年人CAP住院患者多有基础疾病,病原学检查检出率为76．1％,致病菌以G-杆菌为主,检出率依次为肺炎克雷白杆菌、肺炎链球菌、铜绿假单胞菌、大肠埃希菌,流感嗜血杆菌、非典型致病菌等。结论老年人CAP住院患者基础疾病多、临床表现不典型、病原菌复杂,应当引起临床医生的高度重视。     

不同类型老年吸入性肺炎的病原学、抗生素应用及临床转归

目的 比较老年社区获得性吸入性肺炎(CAP)、医疗相关性吸入性肺炎(HCAP)及医院获得性吸入性肺炎(HAP,包括呼吸机相关性吸入性肺炎)三者病原学、抗生素应用及治疗转归的关系.方法 收集2005年1月一2010年12月北京二炮总医院呼吸科住院的216例老年吸人性肺炎患者病例,分析其病原学结果、抗生素应用的及治疗转归.结果 三种吸入性肺炎的病原学有显著差异,与CAP和HCAP相比,HAP患者G-杆菌的感染比例明显增多(P<0.001);抗生素应用方案有明显差异,CAP组病人未调整抗生素应用比率明显高于HCAP组与HAP组(P<0.001);抗生素应用策略不同,所致死亡率有明显差异,以升阶梯方案为最高,以降阶梯治疗为最低(P=0.03).结论 三种吸入性肺炎在感染病原菌种类、抗生素应用策略及治疗转归上有明显差异,应根据不同类型的老年吸入性肺炎特点合理经验性使用抗菌药物.     

Differences in the etiology of community-acquired pneumonia according to site of care: a population-based study

BACKGROUND: A few population-based studies assessing the etiology of community-acquired pneumonia in both hospitalized and ambulatory patients, with special emphasis on the etiologic role of viral infections, have been reported. The purpose of this study was to assess microbiological differences according to initial site of care in patients with community-acquired pneumonia. METHODS: We studied 496 patients > 14 years of age collected from the study samples of three population-based studies carried out in the same geographical area ("Maresme" region in the Mediterranean coast in Barcelona, Spain) with the same methodology over an 8-year period (1987-1995). RESULTS: Fifty-six percent of patients were hospitalized and 44% were treated at home. Of the 474 patients with etiological evaluation, 195 patients had an identifiable etiology (overall diagnostic yield 41%). Streptococcus pneumoniae was the most common causative organism. Viral infection was diagnosed in 26.5% of hospitalized patients vs. 13.2% of ambulatory patients (P=0.03). Twenty-five percent of the 68 patients with documented etiology treated at home had Chlamydia pneumoniae infection compared with 14.3% of those treated in the hospital. Ten percent of hospitalized patients had pneumonia caused by two pathogens compared with 9.7% of ambulatory patients. The association of viruses and bacteria was the most frequent cause of dual infection (79% inpatients, 67% outpatients). CONCLUSIONS: This study has provided information on etiology of community-acquired pneumonia in hospitalized patients and in patients treated at home. A considerable proportion of patients had viral pneumonia, frequently requiring hospital admission for inpatient care.     

Clinical analysis of community-acquired pneumonia in the elderly

OBJECTIVE: To evaluate the clinical features, etiology, and outcome of patients over 65 years old hospitalized for community-acquired pneumonia. PATIENTS: Eighty-four patients (50 males, 34 females) hospitalized for community-acquired pneumonia in Kawasaki Medical School Kawasaki Hospital between April 1998 and March 2000. RESULTS: Most of the patients had respiratory symptoms or signs, but over one-third also had atypical symptoms of pneumonia such as dyspnea, consciousness disturbance, and gastrointestinal symptoms. The causative microorganisms were identified in 48% of these patients. Streptococcus pneumoniae (13%), respiratory viruses (13%), Haemophilus influenzae (8%) and Mycobacterium tuberculosis (8%) were frequently identified, but Mycoplasma pneumoniae was less frequently noted in the elderly. Double infection was recognized in 19 % and a combination of some virus and bacteria in 13%. Treatment consisted of the administration of second or third generation cephalosporin antibiotics intravenously, because antibiotics had already been preadministered in 39%. The prognosis was poor (mortality rate 9%) for the elderly with community-acquired pneumonia despite mechanical ventilation in 8%. CONCLUSIONS: Although the range of microorganisms causing community-acquired pneumonia differed slightly from that in previous reports; namely, lower frequency of Chlamydia pneumoniae and Legionella pneumophila, it is suggested that the initial antibiotic treatment should always cover S. pneumoniae and H. influenzae. In addition, since a prevalence of virus infections related to the increase in community-acquired pneumonia in the elderly was found in this study, the routine use of influenza vaccine and pneumococcal vaccines in the elderly is recommended to reduce the high mortality rate.