Marrie T J, Durant H, Yates L
Department of Medicine, Dalhousie University, Halifax, Nova Scotia.
Rev Infect Dis. 1989 Jul-Aug;11(4):586-99. doi: 10.1093/clinids/11.4.586.
We studied all patients with community-acquired pneumonia who were admitted to our 800-bed adult acute care hospital from 1 November 1981 to 15 March 1987. The 719 patients had a mean age of 63.2 years; 18% were admitted from nursing homes, and 18% required ventilatory assistance as part of the therapy for pneumonia. Patients with nursing home-acquired pneumonia were significantly older; had a higher mortality (40% vs. 17%); were more likely to be admitted in January; were less likely to complain of cough, fever, anorexia, chills, headache, nausea, sore throat, myalgia, or arthralgia; and were more likely to be confused than those admitted from the community. Pneumonia of unknown etiology and aspiration pneumonia were more common and Mycoplasma pneumoniae infection less common among those with nursing home-acquired pneumonia. Streptococcus pneumoniae accounted for 58% of the 48 cases of bacteremia. None of the bacteremic patients received antibiotics before admission, compared with 34% of the nonbacteremic patients. Aerobic gram-negative rod bacteremia was not more frequent among nursing home patients than among those from the community. The overall mortality was 21% (8.5% for those less than 60 years of age and 28.6% for those greater than 60 years old). By multivariate analysis the following variables were significant predictors of mortality: number of lobes involved by the pneumonic process, number of antibiotics used to treat the pneumonia, age, admission from a nursing home, ventilatory support, and the number of complications that occurred while the patient was in the hospital.
我们研究了1981年11月1日至1987年3月15日期间入住我们拥有800张床位的成人急症医院的所有社区获得性肺炎患者。这719名患者的平均年龄为63.2岁；18%来自养老院，18%在肺炎治疗过程中需要通气支持。养老院获得性肺炎患者年龄明显更大；死亡率更高（40%对17%）；更有可能在1月份入院；较少主诉咳嗽、发热、厌食、寒战、头痛、恶心、咽痛、肌痛或关节痛；并且比社区获得性肺炎患者更容易出现意识模糊。病因不明的肺炎和吸入性肺炎在养老院获得性肺炎患者中更常见，而肺炎支原体感染则较少见。肺炎链球菌占48例菌血症病例的58%。菌血症患者入院前均未接受抗生素治疗，而非菌血症患者这一比例为34%。养老院患者需氧革兰氏阴性杆菌菌血症的发生率并不高于社区患者。总体死亡率为21%（60岁以下患者为8.5%，60岁以上患者为28.6%）。多因素分析显示，以下变量是死亡率的显著预测因素：肺炎累及的肺叶数量、用于治疗肺炎的抗生素数量、年龄、来自养老院、通气支持以及患者住院期间发生的并发症数量。
