Pişkin Nihal, Aydemir Hande, Oztoprak Nefise, Akduman Deniz, Celebi Güven, Seremet Keskin Ayşegül
Zonguldak Karaelmas Universitesi Tip Fakültesi, Enfeksiyon Hastaliklari ve Klinik Mikrobiyoloji Anabilim Dali, Zonguldak.
Mikrobiyol Bul. 2009 Oct;43(4):597-606.
Community-acquired pneumonia (CAP) is a common infectious disease with high morbidity and mortality. In this study, demographic features, underlying conditions, causative pathogens and factors affecting length of hospital stay and mortality were retrospectively investigated in patients who were diagnosed as CAP and followed-up in our unit between January 2005-December 2007. Among 97 patients 65 (67%) were male, 32 (33%) were female and the mean age was 62.7 (age range: 18-94) years. Patients were grouped according to criteria of Turkish Thoracic Society into four groups; 22 were group 2 (patients with risk factors, without aggrevating factors), 59 were group 3 (patients with aggrevating factors), and 16 were group 4 (patients who have necessity for intensive care) CAP. The patients have also been grouped according to criteria of American Thoracic Society (CURB-65 score = Confusion, Urea > 7 mmol/L, Respiratory rate > or = 30/min, low Blood pressure and being > or = 65 years old), as group I (n = 65), group II (n = 20), and group III (n = 12). During follow-up 11 (11.3%) patients required mechanical ventilation support and 6 (6.2%) patients have died. Causative pathogens were isolated from 14 (23.3%) out of 27 well-qualified sputum samples obtained from 60 patients who could produce sputum (8 Streptococcus pneumoniae, 2 methicillin-sensitive Staphylococcus aureus, 2 Klebsiella pneumoniae, 1 Haemophilus influenzae, 1 Moraxella catarrhalis). Thirty-seven of cases were treated with levofloxacin, 10 with moxifloxacin, 24 with ceftriaxone +/- clarithromycin, 16 with sulbactam-ampicillin +/- ciprofloxacin, 10 with beta-lactam/beta-lactamase inhibitor combinations, and fever declined within 2.5 days in 83 (85.6%) of them. The mean duration of hospital stay was estimated as 11.1 days. In the evaluation of the factors that affect the length of hospital stay, being > or = 65 years old, gender, underlying conditions, central venous catheterisation, presence of nasogastric tube, positive culture result, previous antibiotic treatment, fever continuing for > 3 days despite antibiotic therapy and scoring groups were not determined as risk factors (p > 0.05 for all of these parameters). However, mechanical ventilation was found as a significant risk factor (p < 0.05). In the evaluation of the factors that affect mortality, mechanical ventilation (p < 0.001), staying in intensive care unit (p < 0.001), being group 4 CAP (p < 0.001) and fever continuing for > 3 days despite antibiotic therapy (p = 0.05) were found to be significant risk factors. In conclusion, length of hospital stay, mortality and treatment costs in CAP patients could be reduced by defining the risk factors and starting empirical antibiotic therapy according to the national and international guidelines.
社区获得性肺炎（CAP）是一种常见的传染病，发病率和死亡率都很高。在本研究中，我们回顾性调查了2005年1月至2007年12月期间在我院确诊为CAP并接受随访的患者的人口统计学特征、基础疾病、致病病原体以及影响住院时间和死亡率的因素。97例患者中，65例（67%）为男性，32例（33%）为女性，平均年龄为62.7岁（年龄范围：18 - 94岁）。根据土耳其胸科学会的标准，患者被分为四组：22例为2组（有危险因素但无加重因素的患者），59例为3组（有加重因素的患者），16例为4组（需要重症监护的CAP患者）。患者还根据美国胸科学会的标准（CURB - 65评分 = 意识模糊、尿素>7 mmol/L、呼吸频率>或 = 30次/分钟、低血压以及年龄>或 = 65岁）分为I组（n = 65）、II组（n = 20）和III组（n = 12）。在随访期间，11例（11.3%）患者需要机械通气支持，6例（6.2%）患者死亡。从60例能够咳痰的患者获取的27份合格痰标本中，14份（23.3%）分离出致病病原体（8例肺炎链球菌、2例甲氧西林敏感金黄色葡萄球菌、2例肺炎克雷伯菌、1例流感嗜血杆菌、1例卡他莫拉菌）。37例患者接受左氧氟沙星治疗，10例接受莫西沙星治疗，24例接受头孢曲松+/-克拉霉素治疗，16例接受舒巴坦-氨苄西林+/-环丙沙星治疗，10例接受β-内酰胺/β-内酰胺酶抑制剂联合治疗，其中83例（85.6%）患者的发热在2.5天内消退。平均住院时间估计为11.1天。在评估影响住院时间的因素时，年龄>或 = 65岁、性别、基础疾病、中心静脉置管、鼻胃管的存在、培养结果阳性、既往抗生素治疗、抗生素治疗后发热持续>3天以及评分分组均未被确定为危险因素（所有这些参数的p>0.05）。然而，机械通气被发现是一个显著的危险因素（p<0.05）。在评估影响死亡率的因素时，机械通气（p<0.001）、入住重症监护病房（p<0.001）、4组CAP（p<0.001）以及抗生素治疗后发热持续>3天（p = 0.05）被发现是显著的危险因素。总之，通过确定危险因素并根据国家和国际指南开始经验性抗生素治疗，可以降低CAP患者的住院时间、死亡率和治疗费用。
