Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, USA.
Clin Microbiol Infect. 2014 Dec;20(12):1316-22. doi: 10.1111/1469-0691.12740. Epub 2014 Dec 12.
The aim of this study was to quantify the value of clinical predictors available in the emergency department (ED) in predicting Streptococcus pneumoniae as the cause of community-acquired pneumonia (CAP). A prospective, observational, cohort study of patients with CAP presenting in the ED was performed. Pneumococcal aetiology of CAP was based on either bacteraemia, or S. pneumoniae being cultured from sputum, or urinary immunochromatographic assay positivity, or positivity of a novel serotype-specific urinary antigen detection test. Multivariate logistic regression was used to identify independent predictors and various cut-off values of probability scores were used to evaluate the usefulness of the model. Three hundred and twenty-eight (31.0%) of 1057 patients with CAP had pneumococcal CAP. Nine independent predictors for pneumococcal pneumonia were identified, but the clinical utility of this prediction model was disappointing, because of low positive predictive values or a small yield. Clinical criteria have insufficient diagnostic capacity to predict pneumococcal CAP. Rapid antigen detection tests are needed to diagnose S. pneumoniae at the time of hospital admission.
本研究旨在量化急诊科（ED）现有临床预测因子对预测肺炎链球菌（SP）引起社区获得性肺炎（CAP）的价值。对急诊科就诊的 CAP 患者进行了前瞻性、观察性、队列研究。CAP 的肺炎球菌病因基于菌血症、从痰中培养出 SP、尿免疫层析法阳性或新型血清型特异性尿抗原检测阳性。多变量逻辑回归用于识别独立预测因子，并使用各种概率评分截断值来评估模型的有用性。在 1057 例 CAP 患者中，328 例（31.0%）为肺炎球菌 CAP。确定了 9 个独立的肺炎球菌肺炎预测因子，但由于阳性预测值较低或产量较小，该预测模型的临床实用性令人失望。临床标准对预测肺炎球菌 CAP 的诊断能力不足。需要在入院时进行快速抗原检测来诊断 SP。
