Fernández Mauricio, Zagolin Mónica, Ruiz Mauricio, Martínez María Angélica, Díaz Juan Carlos
Departamento de Medicina Interna, Hospital Clínico Universidad de Chile, Santos Dumont 999, Santiago, Chile.
Rev Med Chil. 2003 May;131(5):498-504.
Community-acquired pneumonia (CAP) that requires hospitalization, is a common and serious disease. A permanent assessment in specialized centers, to define therapeutic guidelines according to local epidemiological factors, is mandatory.
To study the etiology of CAP requiring hospital admission.
Adult patients with CAP, admitted to the Clinical Hospital of the University of Chile between 1999 and 2001 were studied. A clinical, radiological and microbiological assessment was done in all patients. Blood and sputum cultures and serology for Chlamydia and Mycoplasma pneumoniae were performed.
Thirty one patients aged 62 +/- 18 years, 12 female, met inclusion criteria. An etiologic diagnosis was made in 74% of cases, (52% definitive, 22% probable). Frequency of definitive diagnosis was: 25% Mycoplasma pneumoniae, 19% Chlamydia pneumoniae and 13% Streptococcus pneumoniae. Mixed etiology was found in 16% and a final diagnosis was not obtained in 26% of the cases. No correlation was found between clinical and radiological patterns, and the etiologic agent. C reactive protein and erythrosedimentation rate were significantly higher in CAP due to Chlamydia and Streptococcus pneumoniae.
The higher frequency of Mycoplasma and Chlamydia pneumoniae, than previously reported, suggests that atypical agents should be considered in the initial antimicrobial therapy prescribed to these patients.
需住院治疗的社区获得性肺炎(CAP)是一种常见且严重的疾病。在专业中心进行持续评估,以根据当地流行病学因素确定治疗指南是必要的。
研究需住院治疗的CAP的病因。
对1999年至2001年间入住智利大学临床医院的成年CAP患者进行研究。对所有患者进行临床、放射学和微生物学评估。进行血培养、痰培养以及肺炎衣原体和肺炎支原体血清学检测。
31例患者年龄为62±18岁,其中12例为女性,符合纳入标准。74%的病例做出了病因诊断(52%为确诊,22%为可能诊断)。确诊诊断的频率为:肺炎支原体25%,肺炎衣原体19%,肺炎链球菌13%。16%发现有混合病因,26%的病例未得出最终诊断。临床和放射学表现与病原体之间未发现相关性。衣原体和肺炎链球菌所致CAP患者的C反应蛋白和红细胞沉降率显著更高。
肺炎支原体和肺炎衣原体的发生率高于先前报道,提示在为这些患者开具的初始抗菌治疗中应考虑非典型病原体。