Jover Francisco, Cuadrado José-María, Andreu Lucio, Martínez Silvia, Cañizares Ruth, de la Tabla Victoria Ortiz, Martin Coral, Roig Pablo, Merino Jaime
Infectious Diseases Division, Internal Medicine Department, Hospital of San Juan, Alicante, Spain.
Eur J Intern Med. 2008 Jan;19(1):15-21. doi: 10.1016/j.ejim.2007.03.015. Epub 2007 Sep 19.
Few attempts have been made to compare bacteremic and non-bacteremic pneumococcal pneumonia, mainly because it is difficult to gain agreement on which cases represent non-bacteremic pneumococcal pneumonia. Recently, an immunochromatographic assay for the detection of Streptococcus pneumoniae urinary antigen has been successfully evaluated for the diagnosis of pneumococcal pneumonia. The aim of our study was to examine and compare clinical and radiological features, risk factors, and outcome associated with bacteremic and non-bacteremic groups.
A retrospective study (1995-2003) analyzing the clinical records of patients diagnosed with pneumococcal pneumonia in our institution was performed. S. pneumoniae were identified by blood cultures (bacteremic group) and detection of urinary antigen (non-bacteremic group).
There were 82 patients (57 bacteremic and 25 non-bacteremic). In seven non-bacteremic cases, another etiology was detected, i.e., Legionella (n=1) and Chlamydia pneumoniae (n=6). Bacteremic patients were significantly younger (p=<0.001), more likely to have liver disease (p=0.028), current smokers (p=0.024), alcohol and intravenous drug abusers (p=0.014 and p<0.001, respectively), and infected with HIV (p<0.001). Non-bacteremic patients were more likely to have congestive heart failure (p=0.004), chronic obstructive pulmonary disease (p=0.033) and to be former smokers (p=0.004). Bacteremic cases needed more prolonged intravenous antibiotic treatment (6 days vs. 4.5 days; p=0.006) than non-bacteremic cases and their length of stay was also longer.
In our study, smoking was the leading risk factor for pneumococcal pneumonia. However, current smokers have an increased risk of bacteremic forms and former smokers and patients with COPD developed non-bacteremic forms more frequently. Bacteremic patients need more prolonged intravenous antibiotic treatment than non-bacteremic patients.
很少有人尝试比较菌血症性和非菌血症性肺炎球菌肺炎，主要是因为很难就哪些病例代表非菌血症性肺炎球菌肺炎达成共识。最近，一种用于检测肺炎链球菌尿抗原的免疫层析测定法已成功用于肺炎球菌肺炎的诊断评估。我们研究的目的是检查和比较菌血症组和非菌血症组的临床和放射学特征、危险因素及转归。
进行了一项回顾性研究（1995 - 2003年），分析了我院确诊为肺炎球菌肺炎患者的临床记录。通过血培养（菌血症组）和尿抗原检测（非菌血症组）来鉴定肺炎链球菌。
共有82例患者（57例菌血症患者和25例非菌血症患者）。在7例非菌血症病例中，检测到了其他病因，即嗜肺军团菌（1例）和肺炎衣原体（6例）。菌血症患者明显更年轻（p<0.001），更易患肝病（p = 0.028）、当前吸烟者（p = 0.024）、酗酒者和静脉吸毒者（分别为p = 0.014和p<0.001），以及感染HIV者（p<0.001）。非菌血症患者更易患充血性心力衰竭（p = 0.004）、慢性阻塞性肺疾病（p = 0.033），且为既往吸烟者（p = 0.004）。菌血症病例比非菌血症病例需要更长时间的静脉抗生素治疗（6天对4.5天；p = 0.006），其住院时间也更长。
在我们的研究中，吸烟是肺炎球菌肺炎的主要危险因素。然而，当前吸烟者患菌血症形式的风险增加，既往吸烟者和慢性阻塞性肺疾病患者更易发生非菌血症形式。菌血症患者比非菌血症患者需要更长时间的静脉抗生素治疗。
