Endeman Henrik, Schelfhout Vanessa, Voorn G Paul, van Velzen-Blad Heleen, Grutters Jan C, Biesma Douwe H
Department of Internal Medicine, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands.
Scand J Infect Dis. 2008;40(9):715-20. doi: 10.1080/00365540802014864.
Community acquired pneumonia (CAP) is caused by a variety of microorganisms. By identifying patients at risk for failure of pathogen identification, it is possible to make an early decision on the extent of diagnostic procedures to be performed. This is especially important in patients with severe CAP. The aim of this study was to identify these patients by using clinical and laboratory features. In 201 patients hospitalized for CAP, clinical and laboratory variables were collected. Pathogen identification was performed by culture of sputum and blood, urine antigen tests, polymerase chain reaction of sputum, serological testing and viral culture of the pharynx. In 128 patients a respiratory microorganism was identified. In both univariate and multivariate analysis, failure of pathogen identification was predicted by pre-hospital antibiotic therapy, a medical history of hypertension and a low C-reactive protein. We conclude that patients with pre-hospital antibiotic therapy, a medical history of hypertension and a relatively low C-reactive protein are at risk for failure of pathogen identification. These predictors should be confirmed in a larger population. Invasive testing in high-risk patients with CAP in the presence of these predictors should be considered at an early phase of hospitalization.
社区获得性肺炎（CAP）由多种微生物引起。通过识别病原体鉴定失败风险较高的患者，能够尽早决定所需进行的诊断程序范围。这对于重症CAP患者尤为重要。本研究的目的是利用临床和实验室特征来识别这些患者。在201名因CAP住院的患者中，收集了临床和实验室变量。通过痰液和血液培养、尿抗原检测、痰液聚合酶链反应、血清学检测及咽部病毒培养进行病原体鉴定。128名患者鉴定出呼吸道微生物。在单因素和多因素分析中，院前抗生素治疗、高血压病史及低C反应蛋白可预测病原体鉴定失败。我们得出结论，有院前抗生素治疗史、高血压病史且C反应蛋白相对较低的患者存在病原体鉴定失败的风险。这些预测因素应在更大规模人群中得到证实。对于存在这些预测因素的CAP高危患者，在住院早期应考虑进行侵入性检查。
