Bates J H, Campbell G D, Barron A L, McCracken G A, Morgan P N, Moses E B, Davis C M
John L. McClellan Memorial Veterans Medical Center, Little Rock.
Chest. 1992 Apr;101(4):1005-12. doi: 10.1378/chest.101.4.1005.
The purpose of this study was to determine the microbial etiology of pneumonia by using strict criteria among a group of hospitalized patients. Patients with acute community-acquired or hospital-acquired pneumonia were studied in a systematic and comprehensive manner for bacterial, viral, chlamydial, mycobacterial, and fungal pathogens. A total of 198 patients with 204 episodes of pneumonia were evaluated. Despite 100 percent follow-up of all surviving patients, a specific etiologic agent could be found in only 103 episodes. Among 154 episodes of community-acquired pneumonia, a diagnosis was made in 79; the most common pathogen was from the genus Legionella, followed by various Gram-negative enteric bacteria, Gram-positive cocci, influenza A virus, and Mycoplasma pneumoniae. The etiologic agent was found in 24 of the 50 patients with hospital-acquired pneumonia; no pathogen predominated. We conclude that even when elaborate diagnostic studies are done, including many invasive procedures, the etiology can be determined in only about half of the patients with acute pneumonia. The pathogens of pneumonia in this study are not markedly different between community-acquired and hospital-acquired infection.
本研究的目的是通过对一组住院患者采用严格标准来确定肺炎的微生物病因。对急性社区获得性或医院获得性肺炎患者进行了系统全面的细菌、病毒、衣原体、分枝杆菌和真菌病原体研究。共评估了198例患者的204次肺炎发作。尽管对所有存活患者进行了100%的随访，但仅在103次发作中发现了特定的病原体。在154次社区获得性肺炎发作中，79次作出了诊断；最常见的病原体来自军团菌属，其次是各种革兰氏阴性肠道细菌、革兰氏阳性球菌、甲型流感病毒和肺炎支原体。在50例医院获得性肺炎患者中的24例发现了病原体；没有一种病原体占主导地位。我们得出结论，即使进行了详尽的诊断研究，包括许多侵入性操作，也只能在约一半的急性肺炎患者中确定病因。本研究中社区获得性感染和医院获得性感染的肺炎病原体没有明显差异。
