Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China.
Geriatr Gerontol Int. 2013 Oct;13(4):949-57. doi: 10.1111/ggi.12036. Epub 2013 Feb 26.
Community-acquired pneumonia (CAP) is presumed to be bacterial in origin and empirical antibiotics are almost always given on admission. However, early detection of viral infection is also very important for hospital infection control and timely use of antiviral agents. The present study aimed to compare patients with viral and bacterial pneumonia, and identify independent predictors of viral pneumonia.
A prospective cohort study was carried out in a tertiary teaching hospital in a 1-year period. Older patients (aged ≥ 65 years) were recruited if they were admitted for CAP confirmed by chest radiographs.
A cohort of 488 patients was analyzed. Infective causes were found in 137 (28.1%) patients. Bacterial, viral and mixed infections were detected in 86 (17.6%), 41 (8.4%) and 10 (2.0%) patients, respectively. Bacteriology was established mostly by sputum culture and virology by nasopharyngeal aspirate (NPA) viral culture. The commonest bacterial isolates were Haemophilus influenzae (31), Pseudomonas aeruginosa (15), Mycobacterium tuberculosis (14), Klebsiella spp. (9) and Streptococcus pneumoniae (6). Influenza A virus (28, 8 were pandemic 2009 A/H1N1 subtype) and respiratory syncytial virus (16) were the most frequent viral causes. Independent predictors of viral pneumonia included nursing home residence (RR 3.056, P = 0.009) and absence of leukocytosis (RR 0.425, P = 0.026).
All nursing home residents hospitalized for CAP should undergo NPA viral testing because of infection control, early antiviral treatment and discharge planning. We suggest that empirical antiviral agents might be considered for nursing home residents hospitalized for CAP if outbreaks of influenza-like illness are reported in nursing homes.
社区获得性肺炎（CAP）通常被认为是由细菌引起的，入院时几乎总是给予经验性抗生素。然而，早期发现病毒感染对于医院感染控制和及时使用抗病毒药物也非常重要。本研究旨在比较病毒性和细菌性肺炎患者，并确定病毒性肺炎的独立预测因素。
在一年期间，在一家三级教学医院进行了一项前瞻性队列研究。如果胸部 X 线片证实 CAP 住院的老年患者（年龄≥65 岁）符合条件，则将其纳入研究。
对 488 例患者进行了分析。在 137 例（28.1%）患者中发现了感染原因。细菌、病毒和混合感染分别在 86 例（17.6%）、41 例（8.4%）和 10 例（2.0%）患者中检测到。细菌学主要通过痰培养确定，病毒学通过鼻咽抽吸物（NPA）病毒培养确定。最常见的细菌分离株是流感嗜血杆菌（31 株）、铜绿假单胞菌（15 株）、结核分枝杆菌（14 株）、肺炎克雷伯菌（9 株）和肺炎链球菌（6 株）。甲型流感病毒（28 株，其中 8 株为大流行 2009 年 A/H1N1 亚型）和呼吸道合胞病毒（16 株）是最常见的病毒性病因。病毒性肺炎的独立预测因素包括疗养院居住（RR 3.056，P=0.009）和白细胞减少症（RR 0.425，P=0.026）。
所有因 CAP 住院的疗养院居民都应进行 NPA 病毒检测，以进行感染控制、早期抗病毒治疗和出院计划。如果疗养院报告流感样疾病暴发，我们建议对因 CAP 住院的疗养院居民考虑使用经验性抗病毒药物。
