院外社区获得性肺炎102例临床特点分析

目的分析院外社区获得性肺炎（CAP）的临床特点。方法分析2006年6月～2007年2月102例CAP患者的临床特征。结果102例患者中14～35岁占60,l％,既往身体健康者71．5％,发热后2～5d内80％的患者确认为肺炎,确诊时除发热外咳嗽、咳痰最常见（占53．6％）,另有约32％的患者无呼吸道相关症状,48例患者白细胞计数正常,X线胸片显示单侧肺炎88例占86．3％,对102例患者随诊观察显示,抗生素治疗后约86％患者3天内退热。结论院外CAP大多数发病于青壮年,并发症状少,若诊断及时,多数患者在门诊治疗能取得较好效果。     

重症社区获得性嗜肺军团菌2型肺炎1例报道

正军团菌肺炎是社区获得性肺炎(CAP)的一种。流行病学资料显示,军团菌肺炎占CAP的5.08%~([1])。在住院的军团菌肺炎患者中,近50%需住重症监护室治疗,病情进展快,病死率高~([2])。现将1例重症嗜肺军团菌(Legionella pneumophila,LP)2型肺炎病例进行报道,以提高临床医生对该病的认识。1病历资料患者男,31岁,主诉因"胸痛8 d,发热6 d"于     

老年社区获得性肺炎226例临床和病原学特征分析

目的分析老年社区获得性肺炎的临床和病原学特征。方法回顾性分析阿坝州林业中心医院2005年9月—2008年9月接诊的226例社区获得性肺炎的临床和病原学特征。结果 226例患者均发热,咳嗽、咳痰为常见症状(52.5%),尚有74例(32.74%)无呼吸道症状;114例(50.15%)白细胞计数正常;X线胸片单侧肺炎183例(80.97%);发病后2～4d内50%～80%的患者能被初诊为肺炎。统一留取痰液作病原学培养和药敏试验,革兰氏阴性杆菌139例(61.5%),革兰氏阳性球菌83例(36.7%),真菌4例(1.5%)。氨基糖甙类对革兰氏阴性杆菌有较好的抗菌活性;头孢噻肟的耐药率70%,林可霉素、左氧氟沙星对肺炎链球菌有较好的抗菌活性。抗生素治疗后3d,80%的患者退热。结论在基层医院老年社区获得性肺炎的病原学和临床特征有别于文献报道,部分患者可在门诊治疗。     

支原体重症性肺炎应用皮质激素的探讨

正1年前笔者曾参加会诊一例肺炎支原体重症性肺炎的讨论。支原体肺炎(MP)虽然儿童发病率高,但成人亦不少见,我国7城市12家医院调查社区获得性肺炎(CAP)病原体,MP占20.7%,30岁以下占32.8%,31~50岁占27.8%[1]。发病率已超过肺炎链球菌,为成人CAP的首要致病原,此病为多发常见,值得讨论。此病诊断依据发热、刺激性咳嗽、全身酸痛不适、胸部影像示肺炎征象,如为重症     

老年社区获得性肺炎的病原菌及药敏分析

目的分析老年社区获得性肺炎病原菌分布及抗菌药物敏感性特征。方法分析我院2009～3至2011～3收治102例老年CAP患者,采集呼吸道标本和血标本,进行细菌、肺炎支原体和肺炎衣原体检测。结果 102例CAP患者中,病原学检测阳性56例(54.9%),病原菌68株,其中革兰氏阴性杆菌占57.2%,革兰氏阳性球菌占25.1%,真菌及其它占17.7%,革兰氏阴性杆菌前三位为肺炎克雷伯、大肠埃希菌、铜绿假单胞菌。结论老年社区获得性肺炎感染以革兰氏阴性杆菌感染为主,药敏显示对喹诺酮类及三代头孢菌素有高的耐药性,对含β-内酰胺酶抑制剂的复合抗生素及亚安培南敏感性高。     

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。     

尿抗原检测肺炎链球菌对社区获得性肺炎临床价值研究

正据流行病学统计每年14岁的社区获得性肺炎(CAP)患者约占居民总数的8.3‰,1/4的患者需要住院,病死率约为2.7%~([1])。成人CAP的主要致病菌仍为肺炎链球菌,由于该病原菌传统实验室诊断方法敏感度差,导致一部分CAP的初始治疗抗生素选择失败,不但延误了病情还增加了医疗资源的浪费和患者的经济负担~([2])。尿抗原检测肺炎链球菌是一种体外快速免疫层析(ICT)试验,为肺炎链球菌肺     

C反应蛋白在社区获得性肺炎诊治中的意义

目的探讨C反应蛋白（CRP）在社区获得性肺炎的诊断治疗中的意义。方法应用日立全7080型自动生化分析仪测定社区获得性肺炎200例（住院80例、门诊治疗120例）及健康体检者80例中的CRP水平。结果住院的社区获得性肺炎、门诊治疗的社区获得性肺炎及健康人群之间均存在着显著性差异。结论住院的社区获得性肺炎、门诊治疗的社区获得性肺炎及健康人群之间的CRP存在着阶梯性显著差异。血清CRP水平可一定程度上反映出社区获得性肺炎的严重程度，对患者的治疗及预后评估起到重要作用。     

阿奇霉素联合头孢曲松治疗门诊社区获得性肺炎的疗效观察

目的探讨降低门诊社区获得性肺炎(CAP)初始治疗失败率的方法。方法将582例门诊CAP患者按照指南分别给予青霉素,头孢唑啉,阿奇霉素,左氧氟沙星及头孢曲松联合阿奇霉素治疗。结果单药治疗组与联合治疗组的总有效率分别为62%~69%和78%,有显著性差异(P0.05)。结论阿齐霉素联用头孢曲松可降低门诊社区获得性肺炎(CAP)初始治疗失败率。     

下呼吸道感染病原体构成和耐药特点

了解下呼吸道感染病原体分布及耐药现状,在保证临床疗效的前提下,保护好目前没有耐药或耐药株较少的抗菌药物,避免广谱抗生素的滥用,是临床医生和微生物工作人员共同努力的目标。1社区获得性肺炎(CAP)病原体构成1.1国外CAP病原体构成1门诊CAP患者:细菌培养以肺炎球菌最常见,占9%~20%;血清学检查以肺炎支原体最常见,占13%~37%,肺炎衣原体约占17%,军团菌占0.7%~13%。一项多中心研究发现,CAP的病毒感染占36%。2非ICU的CAP住院患者:北美近30年来的15篇文献回顾分析表明,肺炎球菌是最常见的病原体,占20%~60%;其次是流感嗜血杆菌,占3%~10%…     

Non-infectious and unusual infectious mimics of community-acquired pneumonia

Noninfectious or unusual infectious diseases may present with clinical, radiological and laboratorial characteristics of community-acquired pneumonia (CAP). Usually their presence is only suspected after treatment failure, leading to inappropriate interventions, unnecessary costs and risks related to the untreated potentially life-threatening disease. The present study aimed to assess the noninfectious or unusual infectious diseases that may be misdiagnosed as CAP that progresses with treatment failure. Sixteen hospitalized patients with presumptive diagnosis of CAP and treatment failure were described. The most prevalent symptoms were fever and cough. Radiological pattern of air-space disease was observed in 10 (62%) patients. The diagnosis was established by autopsy (12%) or invasive procedures (88%), as follows: open lung biopsy (nine), flexible fiberoptic bronchoscopy (two), transthoracic fine needle aspiration (two) and bone marrow aspiration (one). Eight patients had noninfectious diseases: pulmonary embolism, cryptogenic organizing pneumonia, Wegener's granulomatosis, hypersensitivity pneumonitis, bronchocentric granulomatosis, neoplastic disease and acute leukemia. The unusual infectious diseases were: tuberculosis, cryptococcosis, actinomycosis, histoplasmosis and paracoccidioidomycosis. Patients with noninfectious or unusual infectious diseases may present with symptoms and radiological findings that mimic CAP. These diseases should always be suspected in patients who do not respond to initial empirical antimicrobial treatment, especially young patients or those without comorbidity.     

Analysis of factors affecting prolonged hospitalizations in elderly patients with community-acquired pneumonia

To determine the factors involved in prolonged hospital stay of elderly patients (over 60 years old) with community-acquired pneumonia (CAP), we investigated: (1) the age, (2) underlying diseases, (3) severity of pneumonia, and (4) length of hospital stay etc. of such cases at a 19-bed local facility. Of the 30 elderly patients with CAP, 20 had no underlying diseases (Group A). The mean length of hospital stay for these patients was about 10 days (mean age 69.1 years). The other 10 patients examined had some chronic underlying diseases, and these patients were assigned to Group B. The mean length of hospital stay in this group was 17 days (mean age was 71.2 years). The finding that the mean length of hospital stay was significantly shorter in Group A than in Group B indicates that prolonged stay of elderly patients with CAP is associated with the presence of underlying chronic diseases. When the severity of pneumonia of patients with underlying chronic diseases increased by one level according to the Guidelines of the Japanese Respiratory Society (2000), the number of patients with moderate pneumonia was 13, and the mean length of hospital stay was 16 days. The number of patients with mild pneumonia was 17, and the mean length of hospital stay was 10 days. Thus, the length of hospitalization was significantly shorter in the mild group than in the moderate group.     

A prospective cohort study of healthcare visits and rehospitalizations after discharge of patients with community-acquired pneumonia

Background and objective: The aim of this study was to identify the frequency of, reasons for, and risk factors associated with additional health‐care visits and re‐hospitalizations (health‐care interactions) among patients with community‐acquired pneumonia (CAP), within 30 days of discharge from hospital. Methods: This was an observational analysis of a prospective cohort of adults hospitalized with CAP at a tertiary hospital in 2007–2009. Additional health‐care interactions were defined as visits to a primary care centre or emergency department, and hospital readmissions within 30 days of discharge. Results: Of the 934 patients hospitalized with CAP, 282 (34.1%) had additional health‐care interactions within 30 days of discharge from hospital; 149 (52.8%) required an additional visit to a primary care centre and 177 (62.8%) attended the emergency department. Seventy‐two patients (25.5%) were readmitted to hospital. The main reasons for additional health‐care interactions were worsening of signs or symptoms of CAP and new or worsening comorbidities that were unrelated to pneumonia, mainly cardiovascular and pulmonary diseases. The only independent factor associated with visits to a primary care centre or the emergency department was alcohol abuse (OR 1.65; 95% CI: 1.03–2.64). Hospitalization in the previous 90 days (OR 2.47; 95% CI: 1.11–5.52) and comorbidities (OR 3.99; 95% CI: 1.12–14.23) were independently associated with re‐hospitalization. Conclusions: Additional health‐care visits and re‐hospitalizations within 30 days of discharge from hospital were common among patients with CAP. This was mainly due to worsening of signs or symptoms of CAP and/or comorbidities. These findings may have implications for discharge planning and follow up of patients with CAP.     

综合性医院呼吸科443例发热患者临床诊断分析

目的探讨呼吸科发热患者的病因构成和临床特点,为发热患者的病因诊断提供有价值的线索。方法回顾性分析2014年1月至2014年12月在安徽医科大学第一附属医院呼吸科住院且最终确诊的发热患者并按年龄分为45岁组,45~59岁组及≥60岁组三组,对临床资料进行回顾性分析。结果 443例发热患者中,感染性疾病321例(72.5%),肺炎最常见168例(37.92%);非感染性疾病122例(27.5%),肺癌105例(23.7%)。45岁组:共有80例,其中感染性疾病71例(88.75%),其中肺炎40例(50.00%);急性气管支气管炎12例(15.00%);结核性胸膜炎10例(12.50%)。非感染性疾病9例(11.25%),其中肺癌7例(8.75%);45~59岁组:共有93例,其中感染性疾病56例(60.21%)肺炎33例(35.48%);肺脓肿、慢阻肺急性加重各5例(均5.38%)。非感染性疾病39例(41.94%),其中肺癌35例(37.53%)。≥60岁组:共有270例,其中感染性疾病195例(72.22%),其中肺炎95例(35.18%);慢阻肺急性加重42例(15.56%)。非感染性疾病75例(27.78%),其中肺癌63例(23.33%);ANCA相关性血管炎8例(2.96%)。结论综合性医院呼吸科发热患者主要病因为感染性疾病,其中肺炎所占比例最高;在非感染性疾病中,各年龄组均以肺癌为首位,应该引起临床上重视。     

儿童甲型H1N1流行性感冒病毒相关性肺炎的临床特征

目的 了解儿童甲型H1N1流行性感冒(流感)病毒相关性肺炎的临床流行特征.方法 通过描述性研究对2009年上海复旦大学附属儿科医院收治的30例甲型H1N1流感病毒所致肺炎的患儿做临床及流行病学分析.中位数比较采用秩和检验,率的比较采用精确卡方检验.结果 30例确诊为甲型H1N1流感合并肺炎的患儿中,年龄中位数为5.9岁,5例有基础疾病史,占16.7%.有明确发热病例暴露史的20例,占66.7%.所有患儿均有发热和咳嗽,11例伴气促,占36.7%,10例伴喘息,占33.3%.11例患儿WBC＜4.0×109/L,占36.7%,2例PLT减少,占6.7%.所有患儿入院时胸部X线片提示肺部有单侧或双侧片状渗出性病灶,4例危重症患儿肺部多处大片状渗出伴肺水肿,占13.3%,1例危重症肺炎患儿发病后3个月和9个月复查胸部CT提示不同程度肺纤维化,占3.3%,3例同时伴纵隔积气和皮下积气,占10.0%,6例并发急性呼吸衰竭,占20.0%,3例伴支气管哮喘急性发作,占10.0%,1例合并脑炎,占3.3%.所有患儿均给予奥司他书和抗菌药物治疗,4例接受机械通气,均治愈或好转出院.发病2 d内和2 d后接受奥司他韦治疗的患儿的热程中位数比较差异有统计学意义(2 d比5 d,Z=-8.015,P＜0.01).结论 学龄前和学龄儿童易感染甲型H1N1流感病毒,可并发严重的肺部疾病.在发病早期采用奥司他韦治疗,可缩短热程,降低危重并发症的发生.     

Retrospective analysis of nursing and healthcare-associated pneumonia: Analysis of adverse prognostic factors and validity of the selection criteria

BackgroundNursing and healthcare-associated pneumonia (NHCAP) is a relatively new condition that was recently defined by the Japanese Respiratory Society. Previous reports and guidelines have not thoroughly investigated the adverse prognostic factors and validity of the selection criteria for NHCAP. The purpose of this research was to clarify the adverse prognostic factors of NHCAP and investigate the validity of the selection criteria with respect to patient deaths.MethodsWe retrospectively analyzed 418 patients with pneumonia who were admitted to our hospital between January 2009 and December 2011.ResultsWe analyzed 215 (51.4%) cases of community-acquired pneumonia (CAP) and 203 (48.6%) cases of NHCAP. NHCAP patients were generally older and had poorer performance status (PS), more complications, and higher levels of mortality than CAP patients. In both groups, the most common causative pathogen was Streptococcus pneumoniae. A multivariate analysis of NHCAP revealed that age≥80 years, oxygen saturation (SpO₂)≤90%, and methicillin-resistant Staphylococcus aureus (MRSA) infection to be independent factors associated with mortality. Of the NHCAP selection criteria, a PS≥3 and a hospitalization history within the past 90 days were adverse prognostic factors in the broad community-acquired pneumonia category (CAP+NHCAP), according to a multivariate analysis. Univariate analysis revealed that admission to an extended care facility or nursing home was associated with death.ConclusionsOur results demonstrated that age≥80 years, SpO₂≤90%, and MRSA infection were adverse prognostic factors for NHCAP patients. Furthermore, we confirmed the validity of the NHCAP selection criteria.     

铜陵地区成人社区获得性肺炎临床特征

目的了解铜陵地区社区获得性肺炎的临床特征。方法调查2006年1月至2009年1月铜陵地区272例社区获得性肺炎的临床资料。结果272例CAP患者中男155例（57．0％）,女117例（43．0％）,平均年龄（55．9±13．5）岁。发热者183例（67．3％）;咳嗽咳痰206例（75．7％）;咯血57例（21．0％）;胸痛31例（11．4％）;胸闷25例（9．2％）;外周血WBC〉10×10^9／L者68例（25．0％）,〈4．0×10^9／L者21例（7．7％）;有肝功能损害45例（20．2％）;存在基础疾病者63例（23．2％）;病变局限于一个肺叶或肺段者184例（67．6％）,双侧或多叶受累者88例（32．4％）;合并单侧或双侧胸腔积液者43例（15．8％）;重症肺炎13例（4．8％）;入选前使用抗菌药物87例（32．0％）;272例CAP患者共分离细菌66株,其中肺炎链球菌和肺炎克雷伯杆菌是最常见的病原体。结论CAP临床表现不典型,在临床工作中应高度重视,尽早进行胸片或肺CT检查,以明确诊断。     

Reasons for coming to hospital after treatment for community-acquired pneumonia on an ambulatory basis

BACKGROUND

Most patients with community-acquired pneumonia (CAP) are treated on an ambulatory basis.

OBJECTIVE

To evaluate the reasons for presentation to hospital after treatment for CAP on an ambulatory basis.

METHODS

The study, conducted in five hospitals in the Capital Health Region (Edmonton, Alberta), enrolled adult patients aged 17 years or older who presented with a history of having been diagnosed and treated for pneumonia within the previous month. A current diagnosis of pneumonia was based on two or more symptoms or signs of CAP, plus radiographic evidence of pneumonia.

RESULTS

Seventy-five (77.3%) of the 97 patients who met the inclusion criteria had CAP, and 22 (22.7%) patients presented with a noninfectious illness. Of the patients with CAP, 25 (33.3%) met the study criteria for worsening of a comorbid illness, 23 (30.7%) had clinical failure, 16 (21.3%) had microbiological failure, six (8.0%) were noncompliant, four (5.3%) had failure of expectations and one (1.3%) had adverse effects of antimicrobial therapy.

CONCLUSIONS

Underlying diseases, exacerbations of comorbidities and complications of CAP, as well as confounders such as unusual infections and noninfectious conditions that mimic CAP, are all reasons for presenting to hospital after treatment for CAP in an ambulatory setting.     

Medium-term survival after hospitalization with community-acquired pneumonia

An episode of community-acquired pneumonia (CAP) has been suggested to predict greater than expected mortality after discharge from hospital. We ascertained the survival status as of December 2002 of a cohort of patients with CAP identified prospectively between November 1998 and June 2001. Cox regression analysis was used to examine the impact of demographic factors, comorbid illnesses, and CAP severity on subsequent mortality. Of 378 CAP survivors we ascertained the survival status of 366 (96.9%), 125 (34.1%) of whom had died. The mean length of follow-up was 1,058 days (range, 602-1,500 days). Independent predictors of mortality were increasing age (p < 0.001), comorbid cerebrovascular (p = 0.002) and cardiovascular (p = 0.023) disease, an altered mental state (p < 0.001), a hematocrit of less than 35% (p = 0.035), and increasing blood glucose level (p = 0.025). In 41- to 80-year-olds without significant comorbidities there was a trend to greater than expected mortality. In conclusion, an episode of CAP in young adults without significant comorbid illnesses does not appear to be an adverse prognostic marker of medium-term survival. The trend to greater than expected mortality in patients over 40 years of age needs further study and physicians should be particularly alert for underlying life-limiting disease processes in patients presenting with acute confusion or a hematocrit of less than 35%.     

Fever in pulmonary embolism.

This study was planned to investigate the characteristics of clinical and laboratory findings of patients with fever diagnosed as pulmonary embolism (PE) in comparison with PE patients without fever and patients with community-acquired pneumonia (CAP). Thirty-nine PE patients with fever without other identifiable causes (18 received antibiotics and 21 did not receive antibiotics) (study groups) were included in the study. 22 patients with PE without fever and 21 patients diagnosed with CAP were retrospectively selected as control groups. Daily peak body temperature, risk factors for PE, symptoms, and physical and laboratory findings at admission were recorded. Patients with CAP demonstrated higher body temperature than PE patients with fever (38.5+/-0.6 versus 37.8+/-0.6 degrees C, P=0.0001). Fever patterns were similar between the three groups of patients who had fever. The leukocyte count and the erythrocyte sedimentation rate (ESR) were slightly higher in the group of PE with fever versus PE without fever (11,465.6+/-4229.4/mm, 51.1+/-34.7/mm/h versus 10,777.3+/-4927.6/mm, 35.2+/-30.1/mm/h, respectively) (P>0.05). The group of CAP showed significantly highest values of leukocyte count and ESR (15,490.5+/-5606.3/mm, 69.1+/-35.9/mm per h, respectively) (P<0.05). This study suggested that fever might accompany with PE. The presence of slight leukocytosis and increased ESR may not securely differentiate PE patients with fever from patients with CAP.