Feikin D R, Schuchat A, Kolczak M, Barrett N L, Harrison L H, Lefkowitz L, McGeer A, Farley M M, Vugia D J, Lexau C, Stefonek K R, Patterson J E, Jorgensen J H
Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Ga. 30333, USA.
Am J Public Health. 2000 Feb;90(2):223-9. doi: 10.2105/ajph.90.2.223.
This study examined epidemiologic factors affecting mortality from pneumococcal pneumonia in 1995 through 1997.
Persons residing in a surveillance area who had community-acquired pneumonia requiring hospitalization and Streptococcus pneumoniae isolated from a sterile site were included in the analysis. Factors affecting mortality were evaluated in univariate and multivariate analyses. The number of deaths from pneumococcal pneumonia requiring hospitalization in the United States in 1996 was estimated.
Of 5837 cases, 12% were fatal. Increased mortality was associated with older age, underlying disease. Asian race, and residence in Toronto/Peel, Ontario. When these factors were controlled for, increased mortality was not associated with resistance to penicillin or cefotaxime. However, when deaths during the first 4 hospital days were excluded, mortality was significantly associated with penicillin minimum inhibitory concentrations of 4.0 or higher and cefotaxime minimum inhibitory concentrations of 2.0 or higher. In 1996, about 7000 to 12,500 deaths occurred in the United States from pneumococcal pneumonia requiring hospitalization.
Older age and underlying disease remain the most important factors influencing death from pneumococcal pneumonia. Mortality was not elevated in most infections with beta-lactam-resistant pneumococci.
本研究调查了1995年至1997年影响肺炎球菌肺炎死亡率的流行病学因素。
分析纳入居住在监测区域、因社区获得性肺炎需住院治疗且从无菌部位分离出肺炎链球菌的患者。在单因素和多因素分析中评估影响死亡率的因素。估算了1996年美国因肺炎球菌肺炎需住院治疗的死亡人数。
5837例病例中，12%为致命病例。死亡率增加与年龄较大、存在基础疾病、亚裔种族以及居住在安大略省多伦多/皮尔区有关。在对这些因素进行控制后，死亡率增加与对青霉素或头孢噻肟耐药无关。然而，排除住院前4天内的死亡病例后，死亡率与青霉素最低抑菌浓度达到或高于4.0以及头孢噻肟最低抑菌浓度达到或高于2.0显著相关。1996年，美国因肺炎球菌肺炎需住院治疗导致的死亡人数约为7000至12500例。
年龄较大和存在基础疾病仍然是影响肺炎球菌肺炎死亡的最重要因素。大多数对β-内酰胺类耐药肺炎球菌感染的死亡率并未升高。
