Department of Internal Medicine, Northeastern Ohio University, College of Medicine, Rootstown, OH, USA.
Postgrad Med. 2010 Mar;122(2):130-41. doi: 10.3810/pgm.2010.03.2130.
To determine the burden of community-acquired pneumonia (CAP) affecting adults in North America, a comprehensive literature review was conducted to examine the incidence, morbidity and mortality, etiology, antibiotic resistance, and economic impact of CAP in this population. In the United States, there were approximately 4.2 million ambulatory care visits for pneumonia in 2006. Pneumonia and influenza continue to be a common cause of death in the United States (ranked eighth) and Canada (ranked seventh). In 2005, there were >60,000 deaths due to pneumonia in persons aged>or=15 years in the United States alone. The hospitalization rate for all infectious diseases increased from 1525 hospitalizations per 100 000 persons in 1998 to 1667 per 100 000 persons in 2005. Admission to an intensive care unit was required in 10% to 20% of patients hospitalized with pneumonia. The mean length of stay for pneumonia was >or=5 days and the 30-day rehospitalization rate was as high as 20%. Mortality was highest for CAP patients who were hospitalized; the 30-day mortality rate was as high as 23%. All-cause mortality for CAP patients was as high as 28% within 1 year. Streptococcus pneumoniae continues to be the most frequently identified pathogen associated with CAP, and pneumococcal resistance to antimicrobials may make treatment more difficult. The economic burden associated with CAP remains substantial at >$17 billion annually in the United States. Despite the availability and widespread adherence to recommended treatment guidelines, CAP continues to present a significant burden in adults. Furthermore, given the aging population in North America, clinicians can expect to encounter an increasing number of adult patients with CAP. Given the significance of the disease burden, the potential benefit of pneumococcal vaccination in adults is substantial.
为了确定影响北美的成人社区获得性肺炎（CAP）的负担，我们进行了一项全面的文献综述，以研究该人群中 CAP 的发病率、发病率和死亡率、病因、抗生素耐药性和经济影响。在美国，2006 年有大约 420 万例门诊治疗肺炎。肺炎和流感仍然是美国（排名第八）和加拿大（排名第七）常见的死亡原因。2005 年，仅在美国，年龄>or=15 岁的人群中因肺炎导致的死亡人数超过 60000 人。所有传染病的住院率从 1998 年的每 10 万人中有 1525 例住院增加到 2005 年的每 10 万人中有 1667 例住院。需要入住重症监护病房的肺炎住院患者占 10%至 20%。肺炎的平均住院时间>or=5 天，30 天再住院率高达 20%。住院的 CAP 患者死亡率最高；30 天死亡率高达 23%。CAP 患者的全因死亡率在 1 年内高达 28%。肺炎链球菌仍然是与 CAP 相关的最常见病原体，而肺炎球菌对抗微生物药物的耐药性可能使治疗更加困难。CAP 在美国每年的相关经济负担仍超过 170 亿美元。尽管有推荐的治疗指南，并且普遍遵守，但 CAP 仍在成人中造成重大负担。此外，由于北美人口老龄化，临床医生预计会遇到越来越多的成人 CAP 患者。鉴于疾病负担的重要性，肺炎球菌疫苗接种对成年人的潜在益处是巨大的。
