Department of Acute and General Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia.
College of Medicine & Public Health, Flinders University, Adelaide, South Australia, Australia.
Intern Med J. 2024 Oct;54(10):1686-1693. doi: 10.1111/imj.16469. Epub 2024 Jul 17.
Community-acquired pneumonia (CAP) leads to considerable morbidity and mortality globally. However, data on CAP burden in Australia, especially during the coronavirus disease 2019 (COVID-19) pandemic, are limited.
We characterised and assessed clinical outcomes of non-COVID-19 CAP hospitalisations over a 6-year period at two major hospitals in South Australia.
All non-COVID-19 CAP hospitalisations were identified using the International Statistical Classification of Diseases and Related Health Problems, Tenth revision, Australian modification (ICD-10-AM) codes, between 1 January 2018 and 31 December 2023, at two tertiary hospitals in Adelaide. Clinical outcomes included in-hospital and 30-day mortality, length of stay (LOS) in, intensive care unit (ICU) admission and 30-day readmissions. Multilevel regression models were utilised to identify predictors of clinical outcomes.
Over the 6-year period, there were 7853 non-COVID-19 CAP hospitalisations, with a temporal increase from 100 per 100 000 population in 2018 to 208 per 100 000 population in 2023 (P < 0.001). The mean (SD) age was 75.1 (17.6) years, and 54.6% were males. The mean age declined over time (P < 0.05), while other characteristics remained stable. Streptococcus pneumoniae was the most commonly identified bacterium (21.8% of cases). In-hospital mortality occurred in 7.8% of patients, with 30-day mortality and readmission rates of 14.3% and 16.9% respectively. LOS declined significantly during the pandemic years; however, mortality remained stable over time. Frailty status, malnutrition and number of comorbidities significantly predicted 30-day mortality and LOS, in addition to pneumonia severity and ICU admission.
There has been an increasing trend of hospitalisations for non-COVID-19 CAP during the COVID-19 pandemic, with a concomitant trend towards shorter LOS and no significant shift in other clinical outcomes.
社区获得性肺炎（CAP）在全球范围内导致了相当高的发病率和死亡率。然而，澳大利亚 CAP 负担的数据，特别是在 2019 年冠状病毒病（COVID-19）大流行期间的数据有限。
我们在南澳大利亚的两家主要医院，对 6 年来非 COVID-19 CAP 住院患者的临床结局进行了描述和评估。
在阿德莱德的两家三级医院，我们使用国际疾病分类第十版，澳大利亚修改版（ICD-10-AM）代码，从 2018 年 1 月 1 日至 2023 年 12 月 31 日，确定所有非 COVID-19 CAP 住院患者。临床结局包括住院和 30 天死亡率、住院时间（LOS）、重症监护病房（ICU）入院和 30 天再入院。我们使用多水平回归模型来确定临床结局的预测因素。
在 6 年期间，有 7853 例非 COVID-19 CAP 住院患者，住院人数从 2018 年的每 10 万人 100 例增加到 2023 年的每 10 万人 208 例（P<0.001）。患者的平均（标准差）年龄为 75.1（17.6）岁，54.6%为男性。平均年龄随时间下降（P<0.05），而其他特征保持稳定。肺炎链球菌是最常见的细菌（占病例的 21.8%）。住院患者的死亡率为 7.8%，30 天死亡率和再入院率分别为 14.3%和 16.9%。在 COVID-19 大流行期间，住院时间显著缩短；然而，死亡率随时间保持稳定。虚弱状态、营养不良和合并症数量除了肺炎严重程度和 ICU 入院外，还显著预测了 30 天死亡率和 LOS。
在 COVID-19 大流行期间，非 COVID-19 CAP 住院患者呈上升趋势，同时住院时间缩短，但其他临床结局没有明显变化。
