Georges H, Leroy O, Vandenbussche C, Guery B, Alfandari S, Tronchon L, Beaucaire G
Service de Réanimation Médicale et Maladies Infectieuses, Lille University Medical School, Centre Hospitalier, Tourcoing, France.
Intensive Care Med. 1999 Feb;25(2):198-206. doi: 10.1007/s001340050816.
To describe risk factors of severe pneumococcal community-acquired pneumonia and to study variables influencing outcome.
Retrospective (1987-1992) and prospective (1993-1995) study.
Three participating ICUs from primary care hospitals.
Five hundred and five patients (mean age: 63 +/- 17 years) with severe community-acquired pneumonia (CAP). Three groups of patients were defined: pneumococcal CAP (group 1), CAP with microbial diagnosis other than Streptococcus pneumoniae (group 2), CAP from group 2 and CAP without microbial diagnosis (group 3).
Admission data and data on the disease's course were recorded. The mean Simplified Acute Physiologic Score (SAPS) was 12.5 +/- 5.4. On admission 288 (57 %) patients were mechanically ventilated (mv) and 82 (16.2 %) required inotropic support. A microbial diagnosis was established for 309 (61.2%) patients. S. pneumoniae was isolated in 137 (27.1%) patients. Severe pneumococcal CAP was independently associated with male sex (p = 0.01), lack of antibiotics use before admission (p = 0.0001), non-aspiration pneumonia (p = 0.01) and septic shock (p = 0.0001). The overall mortality rate was 27.5 % (29.2 % in group 1). In patients with severe pneumococcal CAP, multivariate analysis showed that leukopenia less than 3,500/mm3 (p = 0.0004), age over 65 years (p = 0.01), septic shock (p = 0.01), sepsis related complications (p = 0.0001), ICU complications (p = 0.001) and inadequacy of antimicrobial therapy (p = 0.002) worsened the prognosis.
Few features facilitate the identification of pneumococcal CAP on ICU admission. The prognosis is mostly related to severity of illness (leukopenia, septic shock) while comorbidities do not seem to influence outcome. Sepsis-related disorders, ICU complications and adequate antimicrobial chemotherapy are the major variables affecting the outcome during an ICU stay.
描述重症肺炎球菌社区获得性肺炎的危险因素，并研究影响预后的变量。
回顾性研究（1987 - 1992年）和前瞻性研究（1993 - 1995年）。
来自基层医院的三个参与研究的重症监护病房。
505例重症社区获得性肺炎（CAP）患者（平均年龄：63±17岁）。定义了三组患者：肺炎球菌性CAP（第1组）、微生物诊断为非肺炎链球菌的CAP（第2组）、第2组中的CAP和未进行微生物诊断的CAP（第3组）。
记录入院数据和疾病病程数据。简化急性生理学评分（SAPS）的平均值为12.5±5.4。入院时，288例（57%）患者接受机械通气（mv），82例（16.2%）需要血管活性药物支持。309例（61.2%）患者确立了微生物诊断。137例（27.1%）患者分离出肺炎链球菌。重症肺炎球菌性CAP与男性（p = 0.01）、入院前未使用抗生素（p = 0.0001）、非吸入性肺炎（p = 0.01）和感染性休克（p = 0.0001）独立相关。总死亡率为27.5%（第1组为29.2%）。在重症肺炎球菌性CAP患者中，多因素分析显示白细胞减少低于3500/mm³（p = 0.0004）、年龄超过65岁（p = 0.01）、感染性休克（p = 0.01）、脓毒症相关并发症（p = 0.0001）、重症监护病房并发症（p = 0.001）和抗菌治疗不充分（p = 0.002）会使预后恶化。
在重症监护病房入院时，很少有特征有助于识别肺炎球菌性CAP。预后主要与疾病严重程度（白细胞减少、感染性休克）相关，而合并症似乎不影响预后。脓毒症相关疾病、重症监护病房并发症和充分的抗菌化疗是影响重症监护病房住院期间预后的主要变量。
