Q J Med. 1987 Mar;62(239):195-220.
Four hundred and fifty-three adults in 25 British hospitals entered a prospective study of community-acquired pneumonia. A microbiological diagnosis was established in 67 per cent; Streptococcus pneumoniae (34 per cent). Mycoplasma pneumoniae (18 per cent) and Influenza A virus (7 per cent) were the commonest microorganisms. Our observations support the view that most of those in the microbiologically negative group (33 per cent) had S. pneumoniae infection. In addition to cultures of blood and sputum the most useful initial tests were for sputum pneumococcal antigen and serum mycoplasma specific IgM. Twenty-six patients (5.7 per cent) died, seven within 48 h of admission. Multivariate analyses showed age, absence of chest pain, absence of vomiting, previous treatment with digoxin, tachypnoea, diastolic hypotension, confusion, leucopenia, leucocytosis, and raised blood urea levels were significantly correlated with death. Patients had a 21-fold increased risk of death if they had two of the following: admission respiratory rate greater than or equal to 30/min, admission diastolic BP less than or equal to 60 mmHg, urea greater than 7 mmol/l during admission. Mortality was not related to aetiology except that all three patients with combined Influenza A virus and Staphylococcus aureus infection died. Nine patients had legionella pneumonia; none died. No patients who died from pneumococcal pneumonia, mycoplasma pneumonia or staphylococcal pneumonia had received an appropriate antibiotic before admission. Such deaths are possibly preventable. Assisted ventilation was used in 22 patients of whom 14 survived. Hospital stay in survivors averaged 10.8 days; after six weeks 79 per cent were fit for normal activities, and 55 per cent showed resolution of radiographic signs of pneumonia. We recommend that antibiotics should be given as early as possible and chosen always to cover S. pneumoniae, and in addition M. pneumoniae during outbreaks, and S. aureus during influenza epidemics.
25家英国医院的453名成年人参与了一项社区获得性肺炎的前瞻性研究。67%的患者获得了微生物学诊断；肺炎链球菌（34%）、肺炎支原体（18%）和甲型流感病毒（7%）是最常见的微生物。我们的观察结果支持这样一种观点，即微生物学检测呈阴性的患者组（33%）中的大多数人患有肺炎链球菌感染。除了血液和痰液培养外，最有用的初始检测是痰液肺炎球菌抗原检测和血清支原体特异性IgM检测。26名患者（5.7%）死亡，7人在入院后48小时内死亡。多因素分析显示，年龄、无胸痛、无呕吐、既往使用地高辛治疗、呼吸急促、舒张压低血压、意识模糊、白细胞减少、白细胞增多以及血尿素水平升高与死亡显著相关。如果患者出现以下两种情况，死亡风险会增加21倍：入院时呼吸频率大于或等于30次/分钟、入院时舒张压小于或等于60 mmHg、入院时尿素大于7 mmol/L。死亡率与病因无关，只是三名同时感染甲型流感病毒和金黄色葡萄球菌的患者全部死亡。9名患者患有军团菌肺炎；无人死亡。死于肺炎球菌肺炎、支原体肺炎或葡萄球菌肺炎的患者在入院前均未接受过适当的抗生素治疗。此类死亡可能是可以预防的。22名患者使用了辅助通气，其中14人存活。幸存者的住院时间平均为10.8天；六周后，79%的患者适合正常活动，55%的患者肺炎的影像学表现消失。我们建议应尽早给予抗生素，并且始终选择能覆盖肺炎链球菌的抗生素，此外，在疫情暴发期间要覆盖肺炎支原体，在流感流行期间要覆盖金黄色葡萄球菌。
