Division of Medicine, The Northern Hospital, Melbourne, Australia.
Pathology. 2013 Feb;45(2):162-6. doi: 10.1097/PAT.0b013e32835c76be.
Diagnostic microbiology for community acquired pneumonia (CAP) provides useful information for patient management, infection control and epidemiological surveillance. Newer techniques enhance that information and the time interval for obtaining results. An audit of diagnostic microbiology utilisation, microbiological aetiology, and influence of results on prescribing practices in CAP in a regional Australian hospital setting was performed.
Clinical, microbiological and outcome data were collected by medical record review of patients discharged from Ballarat Hospital with a diagnosis of CAP over a 12 month period.
Of 184 identified CAP episodes, 47 (25.5%) had no diagnostic microbiology performed. Respiratory virus polymerase chain reaction (PCR) was rarely performed (2.7% of all episodes). Acute serology was frequently requested, however paired acute and convalescent serology was infrequently performed (5/75 testing episodes; 6.7%). CAP severity was not correlated with microbiological investigation intensity. The most common pathogens identified were Streptococcus pneumoniae and Mycoplasma pneumoniae (5.4% and 2.2%, respectively). Diagnostic testing appeared to rarely influence antimicrobial prescribing.
In this setting, diagnostic microbiological tests such as respiratory virus PCR and urinary antigen tests are under-utilised. In contrast, sputum and serological investigations are commonly requested, however rarely influence practice. Interventions to facilitate efficient usage of diagnostic microbiology are required.
社区获得性肺炎（CAP）的诊断微生物学为患者管理、感染控制和流行病学监测提供了有用的信息。新技术增强了这些信息和获得结果的时间间隔。在澳大利亚一家地区医院，对 CAP 的诊断微生物学利用、微生物病因学以及结果对处方实践的影响进行了审计。
通过对在 12 个月期间从巴拉瑞特医院出院的 CAP 诊断患者的病历回顾，收集临床、微生物学和结局数据。
在 184 例确诊的 CAP 病例中，有 47 例（25.5%）未进行诊断性微生物学检查。呼吸道病毒聚合酶链反应（PCR）很少进行（所有病例的 2.7%）。急性血清学经常被要求，但很少进行急性和恢复期配对血清学检查（75 次检测中的 5 次；6.7%）。CAP 的严重程度与微生物学检查的强度无关。最常见的病原体是肺炎链球菌和肺炎支原体（分别为 5.4%和 2.2%）。诊断性检测似乎很少影响抗菌药物的使用。
在这种情况下，呼吸道病毒 PCR 和尿抗原检测等诊断性微生物学检查的应用不足。相比之下，痰液和血清学检查经常被要求，但很少影响实践。需要采取干预措施，以促进诊断性微生物学的有效利用。
