Venkatesan P, Gladman J, Macfarlane J T, Barer D, Berman P, Kinnear W, Finch R G
Department of Thoracic Medicine, City Hospital, Nottingham.
Thorax. 1990 Apr;45(4):254-8. doi: 10.1136/thx.45.4.254.
Studies on community acquired pneumonia in the United States in patients over the age of 65 years have shown that Gram negative bacilli account for an appreciable proportion of cases, in addition to usual pathogens such as Streptococcus pneumoniae and Haemophilus influenzae. There have been no reports of community acquired pneumonia in the elderly in the United Kingdom. We undertook such a study to determine the clinical features, aetiology, and outcome. Seventy three patients (38 men) with ages ranging from 65 to 97 (median 79) years were studied prospectively. Pneumonia was defined as an acute lower respiratory tract infection with new, previously unrecorded shadowing on a chest radiograph. Patients with severe chronic illness in whom pneumonia was an expected terminal event were excluded. Nearly all the patients (96%) had respiratory symptoms or signs but many had features that might obscure the true diagnosis of pneumonia. Over half the patients had non-respiratory symptoms and over a third had no systemic signs of infection. A pathogen was identified in 43% of patients, most commonly Streptococcus pneumoniae, Haemophilus influenzae and influenza B virus. Gram negative bacilli were not seen. The mortality rate was high (33%). Early deaths were due to infection whereas later deaths were associated with other factors, such as stroke (two patients) and pulmonary embolism (two patients). Prognostic indicators for mortality were apyrexia, systolic hypotension, increasing hypoxaemia, and new urinary incontinence. As the range of pathogens causing pneumonia was the same in the elderly in this study as in other age groups it is suggested that initial antibiotic treatment for patients in this age group should always cover S pneumoniae and H influenzae.
针对美国65岁以上社区获得性肺炎患者的研究表明，除了肺炎链球菌和流感嗜血杆菌等常见病原体之外，革兰氏阴性杆菌在病例中也占相当比例。英国尚无关于老年人社区获得性肺炎的报道。我们开展了这样一项研究以确定其临床特征、病因及转归。对73例患者（38例男性）进行前瞻性研究，年龄范围为65至97岁（中位数79岁）。肺炎定义为急性下呼吸道感染且胸部X线片出现新的、先前未记录的阴影。将肺炎为预期终末事件的严重慢性病患者排除。几乎所有患者（96%）有呼吸道症状或体征，但许多患者有可能掩盖肺炎真实诊断的特征。超过半数患者有非呼吸道症状，超过三分之一患者无感染的全身体征。43%的患者鉴定出病原体，最常见的是肺炎链球菌、流感嗜血杆菌和乙型流感病毒。未发现革兰氏阴性杆菌。死亡率较高（33%）。早期死亡归因于感染，而后期死亡与其他因素有关，如中风（2例患者）和肺栓塞（2例患者）。死亡的预后指标为无发热、收缩期低血压、低氧血症加重及新发尿失禁。由于本研究中引起肺炎的病原体范围与其他年龄组相同，因此建议该年龄组患者的初始抗生素治疗应始终覆盖肺炎链球菌和流感嗜血杆菌。
