Esposito Susanna, Bosis Samantha, Cavagna Roberta, Faelli Nadia, Begliatti Enrica, Marchisio Paola, Blasi Francesco, Bianchi Ciro, Principi Nicola
Pediatric Department I, Istituto Ricerca e Cura a Carattere Scientifico Maggiore Hospital, University of Milan, 20122 Milan, Italy.
Clin Infect Dis. 2002 Dec 1;35(11):1345-52. doi: 10.1086/344191. Epub 2002 Nov 13.
The characteristics of community-acquired pneumonia associated with Streptococcus pneumoniae infection were compared with those associated with atypical bacterial infection and with mixed S. pneumoniae-atypical bacterial infection in 196 children aged 2-5 years. S. pneumoniae infections were diagnosed in 48 patients (24.5%); atypical bacterial infections, in 46 (23.5%); and mixed infections, in 16 (8.2%). Although white blood cell counts and C-reactive protein levels were higher in patients with pneumococcal infections, no other clinical, laboratory, or radiographic characteristic was significantly correlated with the different etiologic diagnoses. There was no significant difference in the efficacy of the different treatment regimens followed by children with S. pneumoniae infection, whereas clinical failure occurred significantly more frequently among children with atypical bacterial or mixed infection who were not treated with a macrolide. This study shows the major role of both S. pneumoniae and atypical bacteria in the development of community-acquired pneumonia in young children, the limited role of clinical, laboratory, and radiological features in predicting etiology, and the importance of the use of adequate antimicrobial agents for treatment.
对196名2至5岁儿童中，与肺炎链球菌感染相关的社区获得性肺炎的特征，与非典型细菌感染以及肺炎链球菌 - 非典型细菌混合感染相关的社区获得性肺炎的特征进行了比较。48例患者（24.5%）诊断为肺炎链球菌感染；46例（23.5%）为非典型细菌感染；16例（8.2%）为混合感染。虽然肺炎球菌感染患者的白细胞计数和C反应蛋白水平较高，但没有其他临床、实验室或影像学特征与不同的病因诊断显著相关。肺炎链球菌感染儿童采用不同治疗方案的疗效无显著差异，而未接受大环内酯类治疗的非典型细菌或混合感染儿童临床失败的发生率明显更高。这项研究表明，肺炎链球菌和非典型细菌在幼儿社区获得性肺炎的发生中都起主要作用，临床、实验室和放射学特征在预测病因方面作用有限，以及使用适当抗菌药物进行治疗的重要性。
