Carugati Manuela, Aliberti Stefano, Reyes Luis Felipe, Franco Sadud Ricardo, Irfan Muhammad, Prat Cristina, Soni Nilam J, Faverio Paola, Gori Andrea, Blasi Francesco, Restrepo Marcos I
Division of Infectious Diseases, San Gerardo Hospital, ASST Monza, Monza, Italy.
Division of Infectious Diseases and International Health, Duke University, Durham, NC, USA.
ERJ Open Res. 2018 Oct 8;4(4). doi: 10.1183/23120541.00096-2018. eCollection 2018 Oct.
This study aimed to describe real-life microbiological testing of adults hospitalised with community-acquired pneumonia (CAP) and to assess concordance with the 2007 Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) and 2011 European Respiratory Society (ERS) CAP guidelines. This was a cohort study based on the Global Initiative for Methicillin-resistant Pneumonia (GLIMP) database, which contains point-prevalence data on adults hospitalised with CAP across 54 countries during 2015. In total, 3702 patients were included. Testing was performed in 3217 patients, and included blood culture (71.1%), sputum culture (61.8%), urinary antigen test (30.1%), pneumococcal urinary antigen test (30.0%), viral testing (14.9%), acute-phase serology (8.8%), bronchoalveolar lavage culture (8.4%) and pleural fluid culture (3.2%). A pathogen was detected in 1173 (36.5%) patients. Testing attitudes varied significantly according to geography and disease severity. Testing was concordant with IDSA/ATS and ERS guidelines in 16.7% and 23.9% of patients, respectively. IDSA/ATS concordance was higher in Europe than in North America (21.5% 9.8%; p<0.01), while ERS concordance was higher in North America than in Europe (33.5% 19.5%; p<0.01). Testing practices of adults hospitalised with CAP varied significantly by geography and disease severity. There was a wide discordance between real-life testing practices and IDSA/ATS/ERS guideline recommendations.
本研究旨在描述社区获得性肺炎（CAP）住院成人的实际微生物检测情况，并评估其与2007年美国感染病学会（IDSA）/美国胸科学会（ATS）以及2011年欧洲呼吸学会（ERS）的CAP指南的一致性。这是一项基于耐甲氧西林肺炎全球倡议（GLIMP）数据库的队列研究，该数据库包含2015年期间54个国家CAP住院成人的现患率数据。总共纳入了3702例患者。对3217例患者进行了检测，检测项目包括血培养（71.1%）、痰培养（61.8%）、尿抗原检测（30.1%）、肺炎球菌尿抗原检测（30.0%）、病毒检测（14.9%）、急性期血清学检测（8.8%）、支气管肺泡灌洗培养（8.4%）和胸腔积液培养（3.2%）。在1173例（36.5%）患者中检测到病原体。检测态度因地理位置和疾病严重程度而异。分别有16.7%和23.9%的患者检测结果符合IDSA/ATS和ERS指南。IDSA/ATS的一致性在欧洲高于北美（21.5%对9.8%；p<0.01），而ERS的一致性在北美高于欧洲（33.5%对19.5%；p<0.01）。CAP住院成人的检测方法因地理位置和疾病严重程度而异。实际检测方法与IDSA/ATS/ERS指南建议之间存在很大差异。
