美国成年人中需要住院治疗的社区获得性肺炎
Community-Acquired Pneumonia Requiring Hospitalization among U.S. Adults.
作者信息
Jain Seema, Self Wesley H, Wunderink Richard G, Fakhran Sherene, Balk Robert, Bramley Anna M, Reed Carrie, Grijalva Carlos G, Anderson Evan J, Courtney D Mark, Chappell James D, Qi Chao, Hart Eric M, Carroll Frank, Trabue Christopher, Donnelly Helen K, Williams Derek J, Zhu Yuwei, Arnold Sandra R, Ampofo Krow, Waterer Grant W, Levine Min, Lindstrom Stephen, Winchell Jonas M, Katz Jacqueline M, Erdman Dean, Schneider Eileen, Hicks Lauri A, McCullers Jonathan A, Pavia Andrew T, Edwards Kathryn M, Finelli Lyn
机构信息
From the Centers for Disease Control and Prevention, Atlanta (S.J., A.M.B., C.R., M.L., S.L., J.M.W., J.M.K., D.E., E.S., L.A.H., L.F.); Vanderbilt University School of Medicine (W.H.S., C.G.G., J.D.C., F.C., D.J.W., Y.Z., K.M.E.) and University of Tennessee Health Science Center-Saint Thomas Health (C.T.), Nashville, and Le Bonheur Children's Hospital (S.R.A., J.A.M.), University of Tennessee Health Science Center (S.R.A., J.A.M.), and St. Jude Children's Research Hospital (J.A.M.), Memphis - all in Tennessee; Northwestern University Feinberg School of Medicine (R.G.W., E.J.A., D.M.C., C.Q., E.M.H., H.K.D., G.W.W.), John H. Stroger, Jr., Hospital of Cook County (S.F.), and Rush University Medical Center (R.B.) - all in Chicago; University of Utah Health Sciences Center, Salt Lake City (K.A., A.T.P.); and University of Western Australia, Perth (G.W.W.).
出版信息
N Engl J Med. 2015 Jul 30;373(5):415-27. doi: 10.1056/NEJMoa1500245. Epub 2015 Jul 14.
BACKGROUND
Community-acquired pneumonia is a leading infectious cause of hospitalization and death among U.S. adults. Incidence estimates of pneumonia confirmed radiographically and with the use of current laboratory diagnostic tests are needed.
METHODS
We conducted active population-based surveillance for community-acquired pneumonia requiring hospitalization among adults 18 years of age or older in five hospitals in Chicago and Nashville. Patients with recent hospitalization or severe immunosuppression were excluded. Blood, urine, and respiratory specimens were systematically collected for culture, serologic testing, antigen detection, and molecular diagnostic testing. Study radiologists independently reviewed chest radiographs. We calculated population-based incidence rates of community-acquired pneumonia requiring hospitalization according to age and pathogen.
RESULTS
From January 2010 through June 2012, we enrolled 2488 of 3634 eligible adults (68%). Among 2320 adults with radiographic evidence of pneumonia (93%), the median age of the patients was 57 years (interquartile range, 46 to 71); 498 patients (21%) required intensive care, and 52 (2%) died. Among 2259 patients who had radiographic evidence of pneumonia and specimens available for both bacterial and viral testing, a pathogen was detected in 853 (38%): one or more viruses in 530 (23%), bacteria in 247 (11%), bacterial and viral pathogens in 59 (3%), and a fungal or mycobacterial pathogen in 17 (1%). The most common pathogens were human rhinovirus (in 9% of patients), influenza virus (in 6%), and Streptococcus pneumoniae (in 5%). The annual incidence of pneumonia was 24.8 cases (95% confidence interval, 23.5 to 26.1) per 10,000 adults, with the highest rates among adults 65 to 79 years of age (63.0 cases per 10,000 adults) and those 80 years of age or older (164.3 cases per 10,000 adults). For each pathogen, the incidence increased with age.
CONCLUSIONS
The incidence of community-acquired pneumonia requiring hospitalization was highest among the oldest adults. Despite current diagnostic tests, no pathogen was detected in the majority of patients. Respiratory viruses were detected more frequently than bacteria. (Funded by the Influenza Division of the National Center for Immunizations and Respiratory Diseases.).
背景
社区获得性肺炎是美国成年人住院和死亡的主要感染原因。需要通过影像学证实并使用当前实验室诊断测试来估计肺炎的发病率。
方法
我们在芝加哥和纳什维尔的五家医院对18岁及以上需要住院治疗的社区获得性肺炎患者进行了基于人群的主动监测。排除近期住院或严重免疫抑制的患者。系统收集血液、尿液和呼吸道标本进行培养、血清学检测、抗原检测和分子诊断检测。研究放射科医生独立审查胸部X光片。我们根据年龄和病原体计算了需要住院治疗的社区获得性肺炎的人群发病率。
结果
从2010年1月到2012年6月，我们纳入了3634名符合条件的成年人中的2488名（68%）。在2320名有肺炎影像学证据的成年人中（93%），患者的中位年龄为57岁（四分位间距，46至71岁）；498名患者（21%）需要重症监护，52名（2%）死亡。在2259名有肺炎影像学证据且有细菌和病毒检测标本的患者中，853名（38%）检测到病原体：530名（23%）检测到一种或多种病毒，247名（11%）检测到细菌，59名（3%）检测到细菌和病毒病原体，17名（1%）检测到真菌或分枝杆菌病原体。最常见的病原体是人类鼻病毒（9%的患者）、流感病毒（6%）和肺炎链球菌（5%）。每10000名成年人中肺炎的年发病率为24.8例（95%置信区间，23.5至26.1），65至79岁的成年人发病率最高（每10000名成年人中63.0例），80岁及以上的成年人发病率最高（每10000名成年人中164.3例）。对于每种病原体，发病率随年龄增长而增加。
结论
需要住院治疗的社区获得性肺炎的发病率在最年长的成年人中最高。尽管有当前的诊断测试，但大多数患者未检测到病原体。呼吸道病毒的检测频率高于细菌。（由国家免疫和呼吸疾病中心流感司资助。）
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