Department of Medical Microbiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands.
Laboratory of Medical Microbiology and Immunology, St Elisabeth Hospital, Tilburg, the Netherlands.
J Med Microbiol. 2014 Mar;63(Pt 3):441-452. doi: 10.1099/jmm.0.067108-0. Epub 2013 Dec 16.
Current diagnostics for community-acquired pneumonia (CAP) include testing for a wide range of pathogens, which is costly and not always informative. We compared clinical and laboratory parameters of patients with CAP caused by different groups of pathogens to evaluate the potential for targeted diagnostics and directed treatment. In a prospective study, conducted between April 2008 and April 2009, adult patients with CAP were tested for the presence of a broad range of possible respiratory pathogens using bacterial cultures, PCR, urinary antigen testing and serology. Of 408 patients with CAP, pathogens were detected in 263 patients (64.5%). Streptococcus pneumoniae and influenza A virus were the most frequently identified bacterial and viral pathogens, respectively. Age had a significant effect on the prediction of aetiology (P = 0.054), with an increase in the relative contribution of viruses with advancing age. Multivariate analyses further showed that the presence of cough increased the likelihood of detecting a viral pathogen [odds ratio (OR) 5.536, 95% confidence interval (CI) 2.130-14.390], the presence of immunodeficiency decreased the likelihood of detecting a bacterial pathogen (OR 0.595, 95 % CI 0.246-1.437) and an increase in pneumonia severity index score increased the likelihood of detecting a pathogen in general. Although several variables were independently associated with the detection of a pathogen group, substantial overlap meant there were no reliable clinical predictors to distinguish aetiologies. Therefore, testing for common respiratory pathogens is still necessary to optimize treatment.
目前对社区获得性肺炎（CAP）的诊断包括对广泛的病原体进行检测，但这种方法费用高昂且并不总是提供有价值的信息。我们比较了不同病原体组引起的 CAP 患者的临床和实验室参数，以评估靶向诊断和针对性治疗的潜力。在一项前瞻性研究中，我们于 2008 年 4 月至 2009 年 4 月间对成人 CAP 患者进行了广泛的潜在呼吸道病原体检测，包括细菌培养、PCR、尿抗原检测和血清学检测。在 408 例 CAP 患者中，263 例（64.5%）患者检测到病原体。肺炎链球菌和甲型流感病毒分别是最常见的细菌和病毒病原体。年龄对病因预测有显著影响（P=0.054），随着年龄的增长，病毒的相对贡献增加。多变量分析进一步表明，咳嗽的存在增加了检测到病毒病原体的可能性[比值比（OR）5.536，95%置信区间（CI）2.130-14.390]，免疫功能低下降低了检测到细菌病原体的可能性（OR 0.595，95%CI 0.246-1.437），肺炎严重指数评分的增加增加了一般情况下检测到病原体的可能性。尽管有几个变量与病原体组的检测独立相关，但大量重叠意味着没有可靠的临床预测因素来区分病因。因此，检测常见的呼吸道病原体仍然是优化治疗的必要条件。
