Ceccato Adrian, Torres Antoni, Cilloniz Catia, Amaro Rosanel, Gabarrus Albert, Polverino Eva, Prina Elena, Garcia-Vidal Carolina, Muñoz-Conejero Eva, Mendez Cristina, Cifuentes Isabel, Puig de la Bella Casa Jorge, Menendez Rosario, Niederman Michael S
Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, SGR 911, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain; Sección Neumología, Hospital Nacional Alejandro Posadas, El Palomar, Argentina.
Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, SGR 911, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
Chest. 2017 Jun;151(6):1311-1319. doi: 10.1016/j.chest.2017.01.005. Epub 2017 Jan 16.
The burden of pneumococcal disease is measured only through patients with invasive pneumococcal disease. The urinary antigen test (UAT) for pneumococcus has exhibited high sensitivity and specificity. We aimed to compare the pneumococcal pneumonias diagnosed as invasive disease with pneumococcal pneumonias defined by UAT results.
A prospective observational study of consecutive nonimmunosuppressed patients with community-acquired pneumonia was performed from January 2000 to December 2014. Patients were stratified into two groups: invasive pneumococcal pneumonia (IPP) defined as a positive blood culture or pleural fluid culture result and noninvasive pneumococcal pneumonia (NIPP) defined as a positive UAT result with negative blood or pleural fluid culture result.
We analyzed 779 patients (15%) of 5,132, where 361 (46%) had IPP and 418 (54%) had NIPP. Compared with the patients with IPP, those with NIPP presented more frequent chronic pulmonary disease and received previous antibiotics more frequently. Patients with IPP presented more severe community-acquired pneumonia, higher levels of inflammatory markers, and worse oxygenation at admission; more pulmonary complications; greater extrapulmonary complications; longer time to clinical stability; and longer length of hospital stay compared with the NIPP group. Age, chronic liver disease, mechanical ventilation, and acute renal failure were independent risk factors for 30-day crude mortality. Neither IPP nor NIPP was an independent risk factor for 30-day mortality.
A high percentage of confirmed pneumococcal pneumonia is diagnosed by UAT. Despite differences in clinical characteristics and outcomes, IPP is not an independent risk factor for 30-day mortality compared with NIPP, reinforcing the importance of NIPP for pneumococcal pneumonia.
肺炎球菌疾病的负担仅通过侵袭性肺炎球菌疾病患者来衡量。肺炎球菌的尿抗原检测（UAT）已显示出高敏感性和特异性。我们旨在比较被诊断为侵袭性疾病的肺炎球菌肺炎与由UAT结果定义的肺炎球菌肺炎。
对2000年1月至2014年12月连续的非免疫抑制社区获得性肺炎患者进行了一项前瞻性观察研究。患者被分为两组：侵袭性肺炎球菌肺炎（IPP）定义为血培养或胸水培养结果阳性，非侵袭性肺炎球菌肺炎（NIPP）定义为UAT结果阳性且血或胸水培养结果阴性。
我们分析了5132例患者中的779例（15%），其中361例（46%）患有IPP，418例（54%）患有NIPP。与IPP患者相比，NIPP患者慢性肺部疾病更常见，且更频繁地接受过抗生素治疗。IPP患者的社区获得性肺炎更严重，炎症标志物水平更高，入院时氧合更差；肺部并发症更多；肺外并发症更多；达到临床稳定的时间更长；与NIPP组相比住院时间更长。年龄、慢性肝病、机械通气和急性肾衰竭是30天粗死亡率的独立危险因素。IPP和NIPP均不是30天死亡率的独立危险因素。
高比例的确诊肺炎球菌肺炎是通过UAT诊断的。尽管临床特征和结局存在差异，但与NIPP相比，IPP不是30天死亡率的独立危险因素，这强化了NIPP在肺炎球菌肺炎中的重要性。
