Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand Medical School, Johannesburg, South Africa.
Dept of Surgery, Division of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Respir Med. 2024 Nov-Dec;234:107823. doi: 10.1016/j.rmed.2024.107823. Epub 2024 Oct 2.
There is a paucity of data from sub-Saharan Africa describing Severe Community Acquired Pneumonia (SCAP), a condition with significant morbidity and mortality.
This was a retrospective, single-centre, observational study of consecutive patients with SCAP admitted to the ICU at Charlotte Maxeke Johannesburg Academic Hospital, in South Africa between 1 July 2007 and 31 May 2019. Pneumonia was categorised as community-acquired if there had been no hospitalization in the preceding 2 weeks.
We identified 931 patients, (median age 37 [IQR 30-48] years), with the predominant co-morbidity being HIV co-infection (77.1 %). The median CURB-65 and APACHE II scores were 3 (IQR 2-3) and 18 (IQR 14-23) respectively, and most patients had multilobar consolidation on chest X-ray. Mycobacterium tuberculosis was the most common aetiology, followed by Streptococcus pneumoniae. The latter, and Pneumocystis jirovecii were more common amongst survivors and non-survivors, respectively. ICU mortality was 50.1 % and 85 % of patients required ventilation, mostly invasive mechanical ventilation. Ventilated patients and those requiring inotropic support and/or dialysis were more likely to die.
We have described a cohort of patients with SCAP, with a comprehensive overview of all putative microbiological causes, which to our knowledge, is the largest reported in the literature.
撒哈拉以南非洲地区关于严重社区获得性肺炎（SCAP）的数据很少，而该病具有较高的发病率和死亡率。
这是一项回顾性、单中心、观察性研究，纳入了 2007 年 7 月 1 日至 2019 年 5 月 31 日期间在南非夏洛特·马克斯凯 Johannesburg 学术医院 ICU 收治的连续 SCAP 患者。如果患者在过去 2 周内没有住院，则将肺炎归类为社区获得性肺炎。
我们共纳入了 931 例患者（中位年龄 37 [IQR 30-48] 岁），最常见的合并症是 HIV 合并感染（77.1%）。CURB-65 和 APACHE II 评分的中位数分别为 3（IQR 2-3）和 18（IQR 14-23），大多数患者的胸片显示多肺叶实变。结核分枝杆菌是最常见的病原体，其次是肺炎链球菌。存活患者和死亡患者中，肺炎链球菌和卡氏肺孢子虫的检出率分别更高。ICU 死亡率为 50.1%，85%的患者需要通气，主要是有创机械通气。需要通气的患者和需要正性肌力支持和/或透析的患者更有可能死亡。
我们描述了一组 SCAP 患者，全面概述了所有可能的微生物病因，就我们所知，这是文献中报道的最大规模的研究。
