University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
Centre for Remote Health, Flinders NT, Flinders University, Alice Springs, Northern Territory, Australia.
Intern Med J. 2022 Jun;52(6):1048-1056. doi: 10.1111/imj.15171. Epub 2022 May 31.
Severe community-acquired pneumonia (SCAP) has high mortality and morbidity.
To describe the epidemiology and microbiology of SCAP in Central Australia.
A retrospective epidemiological study describing the characteristics, incidence rates (IR) and microbiological aetiology of SCAP in Central Australia. Adult patients admitted to Alice Springs Hospital Intensive Care Unit (ICU) between 2011 and 2014 that fitted the Infectious Diseases Society of America and American Thoracic Society definition of SCAP were included. Medical records were reviewed and compared between indigenous and non-indigenous patients. Primary outcomes were incidence rate and microbiological aetiology of SCAP. Secondary outcomes were 30-day mortality, and ICU and hospital length of stay (LoS).
A total of 185 patents were included (156 indigenous; 29 non-indigenous). The overall SCAP IR per 1000 person-years was 3.24 (3.75 indigenous; 1.87 non-indigenous) with an IR difference of 2.71 after adjustment (P < 0.001). Those aged ≥50 years had an IR 74.8% higher than those younger. Male IR was 50% higher than females. There was a significant difference between indigenous and non-indigenous groups for age (48 vs 64 years), but not for 30-day mortality (7.7% vs 10.3%), ICU LoS (4.8 vs 4.6 days) and hospital LoS (10.9 vs 15.1 days) respectively. Likely causative pathogen(s) were identified in 117 patients; Streptococcus pneumoniae was the most common pathogen (28.2%), followed by Haemophilus influenzae (19.7%), Influenza A/B (16.2%) and Staphylococcus aureus (14.5%).
A high incidence of SCAP was observed in Central Australia, disproportionately affecting the indigenous population. Prevention strategies are imperative, as well as early identification of SCAP and appropriate empiric antibiotic regimens.
严重社区获得性肺炎（SCAP）具有高死亡率和发病率。
描述澳大利亚中部地区 SCAP 的流行病学和微生物学特征。
这是一项回顾性流行病学研究，描述了澳大利亚中部地区 SCAP 的特征、发病率（IR）和微生物病因。纳入 2011 年至 2014 年期间符合美国传染病学会和美国胸科学会 SCAP 定义的入住爱丽丝泉医院重症监护病房（ICU）的成年患者。对病历进行回顾性分析，并比较了土著和非土著患者。主要结局是 SCAP 的发病率和微生物病因。次要结局是 30 天死亡率以及 ICU 和住院时间。
共纳入 185 例患者（156 例土著；29 例非土著）。每 1000 人年的 SCAP 总发病率为 3.24（土著为 3.75；非土著为 1.87），调整后发病率差异为 2.71（P < 0.001）。年龄≥50 岁的患者发病率比年龄较轻的患者高 74.8%。男性发病率比女性高 50%。土著和非土著组在年龄（48 岁比 64 岁）方面有显著差异，但在 30 天死亡率（7.7%比 10.3%）、ICU 住院时间（4.8 天比 4.6 天）和住院时间（10.9 天比 15.1 天）方面无显著差异。在 117 例患者中确定了可能的病原体；肺炎链球菌是最常见的病原体（28.2%），其次是流感嗜血杆菌（19.7%）、甲型流感/乙型流感（16.2%）和金黄色葡萄球菌（14.5%）。
在澳大利亚中部地区观察到 SCAP 发病率较高，土著人群受影响不成比例。需要采取预防策略，以及早期识别 SCAP 和适当的经验性抗生素治疗方案。
