Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
Department of Pulmonary and Critical Care Medicine, Changhai Hospital of Shanghai, Second Military Medical University, Shanghai, China.
J Infect Dis. 2020 Mar 16;221(Suppl 2):S198-S205. doi: 10.1093/infdis/jiz636.
In China, no national survey has been conducted to evaluate physicians' attitudes and compliance with guidelines in the management of adult patients with community-acquired pneumonia (CAP). Therefore, this study aimed to evaluate physicians' awareness of the use of microbiological tests in the management of severe CAP (SCAP) and to investigate the availability of nonculture tests in China.
A nationwide electronic questionnaire survey was conducted among Chinese physicians between March and July 2018, which assessed their viewpoints concerning the issues in the management of SCAP.
A total of 6333 physicians completed this survey, evenly covering all career stages. Among these, 3208 (50.6%) and 1936 (30.6%) had blind spots in the application of blood and sputum cultures in the management of SCAP, respectively. Nonteaching hospital, nonrespirologists, and junior career stage were independently associated with misunderstandings. Regarding nonculture methods, 52.7% of the facilities had no access to polymerase chain reaction-based pathogen detection tests. The accessibility of urinary antigen tests for Streptococcus pneumoniae (42.5%) and Legionella pneumophila (38.5%) was also low. The main barriers were inland and remote region, lower hospital level, and nonteaching hospital.
Insufficient use of sputum and blood cultures, together with low accessibility of major nonculture techniques, were noticeable barriers to achieving microbiological diagnosis of SCAP in China. To help curb the overuse of broad-spectrum antibiotics, further measures should be taken to raise awareness among nonspecialists and promote rapid nonculture tests, especially in nonteaching hospitals and developing regions.
在中国，尚未开展全国性调查来评估医生在成人社区获得性肺炎（CAP）管理中遵循指南的态度和情况。因此，本研究旨在评估医生对重症 CAP（SCAP）管理中微生物学检测应用的认识，并调查中国非培养检测的可及性。
2018 年 3 月至 7 月，采用全国性电子问卷对中国医生进行了调查，评估他们对 SCAP 管理问题的观点。
共 6333 名医生完成了此项调查，涵盖了所有职业阶段。其中，3208 名（50.6%）和 1936 名（30.6%）医生在 SCAP 管理中分别存在血液和痰培养应用的盲区。非教学医院、非呼吸科医生和初级职业阶段与误解独立相关。关于非培养方法，52.7%的机构无法进行基于聚合酶链反应的病原体检测试验。检测肺炎链球菌（42.5%）和嗜肺军团菌（38.5%）的尿抗原试验的可及性也较低。主要障碍为内陆和偏远地区、较低的医院级别和非教学医院。
在中国，痰和血培养应用不足，主要非培养技术的可及性低，这是阻碍 SCAP 微生物学诊断的显著障碍。为了帮助遏制广谱抗生素的过度使用，应采取进一步措施提高非专家的认识，并促进快速非培养检测，尤其是在非教学医院和欠发达地区。
