Thoraxzentrum Ruhrgebiet, Dept of Respiratory and Infectious Diseases, EVK Herne and Augusta-Kranken-Anstalt, Bochum, Germany.
Eur Respir J. 2012 May;39(5):1156-61. doi: 10.1183/09031936.00110911. Epub 2011 Nov 16.
Community-acquired pneumonia (CAP) is now most frequent in elderly patients. CAP in the younger patient has attracted much less attention. Therefore, we compared patients with CAP aged 18 to <65 yrs with those aged ≥ 65 yrs. Data from the prospective multicentre Competence Network for Community Acquired Pneumonia Study Group (CAPNETZ) database were analysed for potential differences in baseline characteristics, comorbidities, clinical presentation, microbial investigations, aetiologies, antimicrobial treatment and outcomes. Overall, 7,803 patients were studied. The proportion of younger patients (aged <65 yrs) was 52.3% (18 to <30 yrs 6.4%; <40 yrs 17.1%; <50 yrs 29.4%). Comorbidity was present in only half of the younger patients (46.6% versus 88.2%). Fever and chest pain were more common. Most younger patients presented with mild CAP (74.0% had a CRB-65 [corrected] score of 0 (confusion of new onset, [corrected] respiratory rate of ≥ 30 breaths · min(-1), blood pressure <90 mmHg or diastolic blood pressure ≤ 60 mmHg, age ≥ 65 yrs)). Overall, Streptococcus pneumoniae and Mycoplasma pneumoniae were the most frequent pathogens in the younger patients. Short-term mortality was very low (1.7% versus 8.2%) and even lower in patients without comorbidity (0.3% versus 2.4%). Long-term mortality was 3.2% versus 15.9%, also lower in patients without comorbidity (0.8% versus 6.1%). Most of the differences found clearly arise after the fifth or within the middle of the sixth decade. CAP in the younger patient is a clinically distinct entity.
社区获得性肺炎（CAP）现在在老年患者中最为常见。年轻患者的 CAP 引起的关注要少得多。因此，我们比较了年龄在 18 岁至<65 岁的 CAP 患者和年龄≥65 岁的患者。对前瞻性多中心社区获得性肺炎研究组（CAPNETZ）数据库的数据进行了分析，以评估潜在的基线特征、合并症、临床表现、微生物学检查、病因、抗菌治疗和预后差异。共研究了 7803 例患者。年轻患者（年龄<65 岁）的比例为 52.3%（18 至<30 岁为 6.4%；<40 岁为 17.1%；<50 岁为 29.4%）。仅有一半的年轻患者存在合并症（46.6%比 88.2%）。发热和胸痛更为常见。大多数年轻患者表现为轻度 CAP（74.0%的 CRB-65 评分[校正]为 0（意识障碍新发生、[校正]呼吸频率≥30 次·min(-1)、血压<90mmHg 或舒张压≤60mmHg、年龄≥65 岁））。总的来说，肺炎链球菌和肺炎支原体是年轻患者中最常见的病原体。短期死亡率非常低（1.7%比 8.2%），无合并症的患者甚至更低（0.3%比 2.4%）。长期死亡率为 3.2%比 15.9%，无合并症的患者也更低（0.8%比 6.1%）。大多数发现的差异主要出现在第五个十年或第六个十年中期之后。年轻患者的 CAP 是一种临床独特的实体。
