Lévy M, Dromer F, Brion N, Leturdu F, Carbon C
Department of Internal Medicine (Intensive care), Hôpital Louis Mourier, Colombes, France.
Chest. 1988 Jan;93(1):43-8. doi: 10.1378/chest.93.1.43.
During a one-year epidemiologic survey of acute community-acquired pneumonia, we prospectively investigated in 116 adult nonimmunocompromised patients (a) the importance of initial noninvasive investigations (ie, blood culture and quantitative sputum culture) and the value of the initial radiologic type of pneumonia in diagnosing of the etiologic agent, and (b) the management of pneumonia. Quantitative sputum culture or blood culture (or both) permitted bacteriologic diagnosis in 44 percent of the cases. The radiologic types found were segmental or alveolar densities in 75 patients (65 percent), patchy alveolar densities in 11 (9 percent), mixed opacities in 26 (22 percent), and interstitial infiltrates in four (3 percent). We observed that (a) the prognosis was identical whether a bacteriologic diagnosis was made or not, (b) the Gram stain, an inexpensive procedure, was as contributive for bacteriologic diagnosis as quantitative sputum culture, diagnosis as (c) blood cultures were poorly contributive in patients without severe infections, and (d) alveolar densities were associated with a bacterial infection in 90 percent of the cases of known etiology. On the basis of these results, a pragmatic strategy of initial management of community-acquired pneumonia is proposed.
在一项为期一年的急性社区获得性肺炎流行病学调查中，我们对116例成年非免疫功能低下患者进行了前瞻性研究：(a) 初始非侵入性检查（即血培养和定量痰培养）的重要性以及初始肺炎放射学类型在病因诊断中的价值；(b) 肺炎的管理。定量痰培养或血培养（或两者）在44%的病例中实现了细菌学诊断。发现的放射学类型为：75例患者（65%）表现为节段性或肺泡性实变，11例（9%）表现为斑片状肺泡实变，26例（22%）表现为混合性混浊，4例（3%）表现为间质性浸润。我们观察到：(a) 无论是否做出细菌学诊断，预后相同；(b) 革兰氏染色这一低成本检查在细菌学诊断中的作用与定量痰培养相同；(c) 在无严重感染的患者中，血培养的诊断价值不大；(d) 在已知病因的病例中，90%的肺泡性实变与细菌感染有关。基于这些结果，我们提出了一种社区获得性肺炎初始管理的实用策略。
